Abciximab in primary coronary stenting of ST-elevation myocardial infarction
Evidence Summaries Level of Evidence = A
Abciximab reduces death and reinfarction rates in patients undergoing primary stenting for acute ST-elevation myocardial infarction (STEMI).
A systematic review 1 including 3 studies with a total of 1101 subjects was abstracted in DARE. Studies of patients with clinically defined STEMI treated with reperfusion therapy without fibrinolytic agents and with primary stenting were eligible for inclusion; studies had to use no angiographic selection criteria. The patients in the included studies had moderate- to high-risk characteristics (acute anterior myocardial infarction 41%, cardiogenic shock 8.4% previous coronary artery bypass grafting 3.1%), and most were male (78%). Between 53% and 70% of patients were diabetics. All patients in the included studies received aspirin and unfractionated heparin in addition to thienopyridine after stenting. Bare stents were used in all patients. Follow-up time was 1 to 3 years. Abciximab was associated with a statistically significant reduction in the cumulative hazard rate for death or reinfarction compared with placebo (12.9% versus 19.0%; RR 0.63, 95% CI 0.45 to 0.89; NNT 19, 95% CI 11 to 135). Abciximab was associated with a reduction in the cumulative hazard rate for death at the limit of statistical significance (10.8% versus 14.3%; RR 0.70, 95% CI 0.48 to 1.00, p=0.052) and a statistically significant reduction in the cumulative hazard rate for reinfarction (2.3% versus 5.5%; RR 0.41. 95% CI 0.20 to 0.83; NNT 31, 95% CI 18 to 133). There was no statistically significant difference between abciximab (2.5%) and placebo (2.0%) in the rate of major bleeding (p>0.5).
In control treatment arms, death or cumulative myocardial infarction rates and death rates were four times higher among diabetics compared with nondiabetics (54% versus 13.5% and 39.7% versus 10.1%, respectively). The subgroup analysis showed that, in diabetics, abciximab was associated with a significant reduction in death or reinfarction compared with placebo (RR 0.53, 95% CI 0.30 to 0.91; NNT 6, 95% CI 4 to 64). In hypertensive patients, abciximab was associated with a significant reduction in reinfarction (RR 0.21, 95% CI 0.06 to 0.74) and death or reinfarction (RR 0.56, 95% CI 0.36 to 0.88) compared with placebo.
1. Montalescot G, Antoniucci D, Kastrati A, Neumann FJ, Borentain M, Migliorini A, Boutron C, Collet JP, Vicaut E. Abciximab in primary coronary stenting of ST-elevation myocardial infarction: a European meta-analysis on individual patients' data with long-term follow-up. Eur Heart J. 2007;28(4):443-9
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