Abciximab as adjunctive therapy to reperfusion in acute ST-segment elevation myocardial infarction - A meta-analysis of randomized trials

被引:439
作者
De Luca, G
Suryapranata, H
Stone, GW
Antoniucci, D
Tcheng, JE
Neumann, FJ
Van de Werf, F
Antman, EM
Topol, EJ
机构
[1] Hosp Weezenlanden, Isala Klinieken, NL-8011 JW Zwolle, Netherlands
[2] Cardiovasc Res Fdn, Lenox Hill Hosp, New York, NY USA
[3] Vasc Inst, New York, NY USA
[4] Careggi Hosp, Div Cardiol, Florence, Italy
[5] Duke Clin Res Inst, Durham, NC USA
[6] Tech Univ Munich, Med Klin, D-8000 Munich, Germany
[7] Univ Hosp Gasthuisberg, Dept Cardiol, B-3000 Louvain, Belgium
[8] Brigham & Womens Hosp, Div Cardiovasc, Boston, MA 02115 USA
[9] Cleveland Clin Fdn, Cleveland, OH 44195 USA
来源
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2005年 / 293卷 / 14期
关键词
D O I
10.1001/jama.293.14.1759
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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 STEM. 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, 14513 [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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收藏
页码:1759 / 1765
页数:7
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