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

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: (i) 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% Cl 0.50-0.97), TVR (0.79, 95% CI 0.65-0.96) and MACE (0.76, 95% Cl 0.65-0.90). Reduction on TVR and MACE was confirmed in stent patients, bug 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% Cl 1.10-3.28) and not with a bolus of 70U/kg (OR 1.22, 95% Cl 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 70U/kg heparin bolus must be used to avoid major bleeding.