| Abciximab as adjunctive therapy to reperfusion in acute ST-segment elevation myocardial infarction: a meta-analysis of randomized trials. | |
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MedLine Citation:
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PMID: 15827315 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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CONTEXT: The benefits of abciximab in patients with ST-segment elevation myocardial infarction (STEMI) are still a matter of debate. OBJECTIVE: To combine data from all randomized trials conducted with abciximab in STEMI. DATA SOURCES: Formal searches of electronic databases (MEDLINE, PubMed) from from January 1990 to December 2004. STUDY SELECTION: We examined all completed, published, randomized trials of abciximab in STEMI. The following key words were used for study selection: randomized trial, myocardial infarction, reperfusion, primary angioplasty, facilitated angioplasty, stenting, fibrinolysis, IIb-IIIa inhibitors, and abciximab. DATA EXTRACTION: Information on study design, type and dosage of drugs, inclusion and exclusion criteria, number of patients, and clinical outcome was extracted by 2 investigators. Disagreements were resolved by consensus. DATA SYNTHESIS: Eleven trials were analyzed, involving 27115 patients (12,602 [46.5%] in the abciximab group, 14,513 [53.5%] in the control group). When compared with the control group, abciximab was associated with a significant reduction in short-term (30 days) mortality (2.4% vs 3.4%, P = .047) and long-term (6-12 months) mortality (4.4% vs 6.2%, P = .01) in patients undergoing primary angioplasty but not in those treated with fibrinolysis or in all trials combined. Abciximab was associated with a significant reduction in 30-day reinfarction, both in all trials combined (2.1% vs 3.3%, P<.001), in primary angioplasty (1.0% vs 1.9%, P = .03), and in fibrinolysis trials (2.3% vs 3.6%, P<.001). Abciximab did not result in an increased risk of intracranial bleeding (0.61% vs 0.62%, P = .62) but was associated with an increased risk of major bleeding complications when combined with fibrinolysis (5.2% vs 3.1%, P<.001) but not with primary angioplasty (4.7% vs 4.1%, P = .36). CONCLUSIONS: This meta-analysis shows that, when compared with the control group, adjunctive abciximab for STEMI is associated with a significant reduction in 30-day and long-term mortality in patients treated with primary angioplasty but not in those receiving fibrinolysis. The 30-day reinfarction rate is significantly reduced in patients treated with either fibrinolysis or primary angioplasty. A higher risk of major bleeding complications is observed with abciximab in association with fibrinolysis. |
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Authors:
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Giuseppe De Luca; Harry Suryapranata; Gregg W Stone; David Antoniucci; James E Tcheng; Franz-Josef Neumann; Frans Van de Werf; Elliott M Antman; Eric J Topol |
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Publication Detail:
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Type: Journal Article; Meta-Analysis |
Journal Detail:
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Title: JAMA : the journal of the American Medical Association Volume: 293 ISSN: 1538-3598 ISO Abbreviation: JAMA Publication Date: 2005 Apr |
Date Detail:
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Created Date: 2005-04-13 Completed Date: 2005-04-18 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 7501160 Medline TA: JAMA Country: United States |
Other Details:
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Languages: eng Pagination: 1759-65 Citation Subset: AIM; IM |
Affiliation:
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Isala Klinieken, Hospital De Weezenlanden, Zwolle, The Netherlands. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Angioplasty, Transluminal, Percutaneous Coronary Antibodies, Monoclonal / therapeutic use* Chemotherapy, Adjuvant Humans Immunoglobulin Fab Fragments / therapeutic use* Myocardial Infarction / drug therapy*, therapy Platelet Aggregation Inhibitors / therapeutic use* Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors Randomized Controlled Trials as Topic Survival Analysis |
| Chemical | |
Reg. No./Substance:
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0/Antibodies, Monoclonal; 0/Immunoglobulin Fab Fragments; 0/Platelet Aggregation Inhibitors; 0/Platelet Glycoprotein GPIIb-IIIa Complex; 143653-53-6/abciximab |
| Comments/Corrections | |
Comment In:
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JAMA. 2005 Oct 12;294(14):1760-1; author reply 1761
[PMID:
16219877
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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