Efficacy and safety of abciximab on acute myocardial infarction treated with percutaneous coronary interventions: A meta-analysis of randomized, controlled trials

de Queiroz Fernandes Araújo, João Otávio; Veloso, Henrique Horta; Braga De Paiva, Joyce Morgana; Filho, Mohamed Wafae; Vincenzo De Paola, Angelo Amato

doi:10.1016/j.ahj.2004.05.047

« Previous Next »American Heart Journal
Volume 148, Issue 6 , Pages 937-943, December 2004

Efficacy and safety of abciximab on acute myocardial infarction treated with percutaneous coronary interventions: A meta-analysis of randomized, controlled trials

João Otávio de Queiroz Fernandes Araújo, MD
- VOTCOR – Hospital da Venerável Ordem Terceira da Penitência, Rio de Janeiro, Brazil
- Reprint requests: Dr. João Otávio de Araújo, Hospital da Venerável Ordem Terceira da Penitência VOTCOR, Rua Conde de Bonfim 1033, Tijuca, Rio de Janeiro RJ20530-001, Brazil,
Henrique Horta Veloso, MD, ScD
- VOTCOR – Hospital da Venerável Ordem Terceira da Penitência, Rio de Janeiro, Brazil
Joyce Morgana Braga De Paiva, MD
- VOTCOR – Hospital da Venerável Ordem Terceira da Penitência, Rio de Janeiro, Brazil
Mohamed Wafae Filho, MD
- VOTCOR – Hospital da Venerável Ordem Terceira da Penitência, Rio de Janeiro, Brazil
Angelo Amato Vincenzo De Paola, MD, ScD
- Department of Cardiology, Escola Paulista de Medicina – Universidade Federal de São Paulo, São Paulo, Brazil

Received 5 February 2004; accepted 18 May 2004.

Abstract

Objective

To evaluate the efficacy and safety of abciximab following acute myocardial infarction (AMI) treated with percutaneous coronary interventions.

Methods

A meta–analysis of randomized controlled trials of platelet glycoprotein IIb/IIIa inhibitor abciximab as adjunctive therapy to percutaneous coronary interventions for AMI was performed. Main outcomes measured were: (1) mortality, (2) reinfarction, (3) target vessel revascularization (TVR), (4) major cardiac events (MACE) that were a composite endpoint of death, reinfarction, and TVR, and (5) major bleeding.

Results

Six trials randomized 3755 patients who were followed for a mean of 5.5 months. Compared with the control, abciximab significantly reduced mortality (OR 0.70, 95% CI 0.50–0.97), TVR (0.79, 95% CI 0.65–0.96) and MACE (0.76, 95% CI 0.65–0.90). Reduction on TVR and MACE was confirmed in stent patients, but not in balloon angioplasty patients. Abciximab was associated with an increased risk of major bleeding (OR 1.39, 95% CI 1.03–1.87), but bleeding was observed only with a 100U/kg heparin bolus followed by a maintenance infusion (OR 1.89, 95% CI 1.10–3.28) and not with a bolus of 70U/kg (OR 1.22, 95% CI 0.85–1.73).

Conclusions

Abciximab, as adjunctive therapy to percutaneous coronary interventions, reduces mortality, TVR and MACE following AMI. The reduction of clinical outcomes occurs with stent implantation but not with balloon angioplasty. A 70U/kg heparin bolus must be used to avoid major bleeding.