Allan D. Kitching, MD; Robert Weiss, MD
Kitching AD, Weiss R. Abciximab plus stenting reduced coronary events in patients with acute myocardial infarction. Ann Intern Med. 2002;136:89. doi: 10.7326/ACPJC-2002-136-3-089
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Published: Ann Intern Med. 2002;136(3):89.
In patients with acute myocardial infarction (MI), is abciximab plus stenting more effective than placebo plus stenting for reducing coronary events?
Randomized (unclear allocation concealment*), blinded (clinicians, patients, and outcome assessors),* placebo-controlled trial with 6-month follow-up.
26 centers in France.
300 patients (mean age 61 y, 82% men) who were > 18 years of age, had had the first symptoms of MI within 12 hours before enrollment, and had ST-segment elevation of > 1 mm in ≥ 2 contiguous electrocardiographic leads. Exclusion criteria were bleeding diathesis; administration of thrombolytic agents for the current episode; neoplasm; recent stroke; uncontrolled hypertension; recent surgery; oral anticoagulant therapy; limited life expectancy; child-bearing potential; and known contraindications to aspirin, ticlopidine, or heparin. Follow-up was 100%.
149 patients were allocated to abciximab (bolus of 0.25 mg/kg of body weight, followed by a 12-hour infusion of 0.125 µg/kg per min) plus stenting (the treatment group); 151 patients were allocated to placebo plus stenting (the control group).
The main outcome was a composite of death, reinfarction, or urgent revascularization of the target vessel at 30 days. The major secondary outcome was a composite of death, reinfarction, or any revascularization at 30 days and at 6 months.
Analysis was by intention to treat. At 30 days, the incidence of the composite end point of death, reinfarction, or urgent target-vessel revascularization and the incidence of the composite end point of death, reinfarction, or any revascularization were lower in the treatment than in the control group (Table). At 6 months, the incidence of the composite end point of death, reinfarction, or any revascularization was lower in the treatment than in the control group (Table).
In patients with acute myocardial infarction, abciximab plus stenting was more effective than placebo plus stenting for reducing coronary events.
Abciximab plus stenting vs placebo plus stenting for acute myocardial infarction†
†Abbreviations defined in Glossary; RRR, NNT, and CI calculated from data in article.
‡Composite 1 = death, reinfarction, or urgent target-vessel revascularization; composite 2 = death, reinfarction, or any revascularization.
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Cardiology, Emergency Medicine, Acute Coronary Syndromes, Coronary Heart Disease.
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