January 25, 2007Open Access
View Full PaperAbciximab in primary coronary stenting of ST-elevation myocardial infarction: a European meta-analysis on individual patients' data with long-term follow-up
Key Points
- This study aims to evaluate the effectiveness of abciximab in reducing mortality and re-infarction in patients undergoing primary coronary stenting for STEMI.
- Conducted a meta-analysis of individual patient data from relevant trials including ISAR-2, ADMIRAL, and ACE.
Structured PICO
Does abciximab reduce the composite of death or re-infarction in patients undergoing primary stenting for STEMI?
P
Population
1101 patients presenting for primary PCI and stenting of STEMI, pooled from 3 studies (ISAR-2, ADMIRAL, ACE). High-risk characteristics included 41% anterior MI, 30% prior MI, 8.4% cardiogenic shock, and 3.1% previous CABG.
I
Intervention
Abciximab (n=550)
C
Comparator
Placebo (n=551)
O
Outcome
Composite of death or re-infarction up to 3 years of follow-upcomposite
Abciximab significantly reduces the long-term composite risk of death or re-infarction in patients undergoing primary stenting for STEMI, with particular benefit in diabetic patients.
Abstract
AIMS: Varying results have been reported in studies evaluating glycoprotein (GP) IIb/IIIa inhibition in primary coronary stenting of acute ST-elevation myocardial infarction (STEMI), usually with limited clinical follow-up. We performed a meta-analysis on case specific data of primary stenting in STEMI with a long-term evaluation. METHODS AND RESULTS: For this meta-analysis, studies of rescue percutaneous coronary intervention (PCI) after failed lytic therapy, plain balloon angioplasty studies and studies with an angiographic selection of patients were excluded. The ISAR-2, ADMIRAL, and ACE studies fulfilled inclusion criteria and all individual data were analysed together. The primary endpoint was the composite of death or re-infarction up to 3 years of follow-up. A total of 1101 patients, presenting for primary PCI and stenting of STEMI were randomized to abciximab (n=550) or placebo (n=551). This population had high-risk characteristics with 41% of anterior MI, 30% with a prior history of MI, 8.4% of cardiogenic shock, and 3.1% of previous coronary artery bypass graft (CABG). The primary endpoint of death or re-infarction was significantly reduced from an estimated cumulative hazard rate of 19.0% with placebo to 12.9% with abciximab RR(95% IC): 0.633 (0.452; 0.887), P=0.008. The mortality rate was reduced from an estimated cumulative hazard rate of 14.3% in the placebo arm to 10.9% in the abciximab arm 0.695 (0.482; 1.003), P=0.052. Re-infarction was reduced from an estimated cumulative hazard rate of 5.5% with placebo to 2.3% with abciximab 0.41 (0.203; 0.831), P=0.013. Major bleedings were 2.5 and 2% with and without abciximab, respectively (NS). In the control arm, both the death or MI cumulative hazard rate (54 vs. 13.5%) and mortality rate (39.7 vs. 10.1%) were four-fold higher in diabetics when compared with non-diabetics. Abciximab provided a significant benefit on the primary endpoint for diabetics 0.525 (0.303; 0.911), P=0.022. CONCLUSION: Abciximab has a strong and persistent impact on hard clinical endpoints in patients undergoing primary stenting for STEMI.