Key result
Abciximab fails to reduce 30-day death in STEMI PCI but lowers 6-month major events.
Why the study?
Abciximab has long-term efficacy in STEMI patients undergoing PCI, but its short-term efficacy remained controversial.
Does abciximab improve short-term clinical outcomes in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention?
Meta-Analysis (n=5,008)
Does abciximab improve short-term clinical outcomes in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention?
Effect estimate: RR 0.79 (95% CI 0.55-1.12)
p-value: p=0.18
In STEMI patients undergoing PCI, abciximab improves 6-month mortality and ischemic outcomes but increases the risk of minor bleeding and thrombocytopenia.
Objectives. This meta-analysis was to verify the short-time efficacy and safety of abciximab in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). Background. Abciximab has long-term efficacy in patients with STEMI undergoing PCI, but the short-term efficacy is still controversial. Methods. We conducted a systematic review and meta-analysis compared with or without abciximab in patients with STEMI undergoing PCI. The relevant randomized controlled trials were included by searching PubMed, EMBASE, Cochrane Library, and Web of Science databases and other sources. The relative risk (RR) and 95% confidence intervals (CI) of outcomes were calculated by the fixed-effects model. Results. Ten randomized controlled trials with 5008 patients met inclusion criteria. There were no significant differences in risk of all-cause death at 30-day (RR 0.79, CI 0.55–1.12, <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"> <a:mi>P</a:mi> <a:mo>=</a:mo> <a:mn>0.18</a:mn> </a:math> ), major bleeding (1.37, 0.93–2.03, <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"> <c:mi>P</c:mi> <c:mo>=</c:mo> <c:mn>0.11</c:mn> </c:math> ), and transfusion (1.23, 0.94–1.61, <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"> <e:mi>P</e:mi> <e:mo>=</e:mo> <e:mn>0.13</e:mn> </e:math> ) between the two groups. However, there were significant differences in risk of all-cause death at 6 months (0.57, 0.36–0.90, <g:math xmlns:g="http://www.w3.org/1998/Math/MathML" id="M4"> <g:mi>P</g:mi> <g:mo>=</g:mo> <g:mn>0.02</g:mn> </g:math> ), recurrent myocardial infarction (0.55, 0.33–0.92, <i:math xmlns:i="http://www.w3.org/1998/Math/MathML" id="M5"> <i:mi>P</i:mi> <i:mo>=</i:mo> <i:mn>0.02</i:mn> </i:math> ), repeat revascularization (0.58, 0.43–0.78, <k:math xmlns:k="http://www.w3.org/1998/Math/MathML" id="M6"> <k:mi>P</k:mi> <k:mo>=</k:mo> <k:mn>0.0004</k:mn> </k:math> ), final TIMI flow <3 (0.77, 0.62–0.96, <m:math xmlns:m="http://www.w3.org/1998/Math/MathML" id="M7"> <m:mi>P</m:mi> <m:mo>=</m:mo> <m:mn>0.02</m:mn> </m:math> ), minor bleeding (1.29, 1.02–1.63, <o:math xmlns:o="http://www.w3.org/1998/Math/MathML" id="M8"> <o:mi>P</o:mi> <o:mo>=</o:mo> <o:mn>0.04</o:mn> </o:math> ), and thrombocytopenia (2.04, 1.40–2.97, <q:math xmlns:q="http://www.w3.org/1998/Math/MathML" id="M9"> <q:mi>P</q:mi> <q:mo>=</q:mo> <q:mn>0.0002</q:mn> </q:math> ). Conclusions. The application of abciximab can lead to a lower risk of reinfarction, revascularization, and all-cause death at 6 months, but a higher risk of minor bleeding, and thrombocytopenia.
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Bai et al. (2022) conducted a meta-analysis in ST-segment elevation myocardial infarction (STEMI) (n=5,008). abciximab vs. without abciximab was evaluated on all-cause death at 30-day (RR 0.79, 95% CI 0.55-1.12, p=0.18). Abciximab in STEMI patients undergoing PCI did not reduce 30-day all-cause death (RR 0.79; 95% CI 0.55-1.12; P=0.18) but lowered 6-month death, reinfarction, and revascularization.
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