Unstable angina: abciximab had no clear effect on long-term mortality.

Clinical bottom line (level 1b-)

  1. Patients with refractory unstable angina who were given abciximab after percutaneous transluminal coronary angioplasty were less likely to be dead at 30 days than those given placebo (NNT = 22 at 30 days) , but by 6 months this difference had disappeared.
The CAPTURE Investigators : Lancet 1997; 349: 1429-1435
Expires March 2003

The study

Single-blinded concealed randomised trial ?with intention-to-treat
Setting: 69 centres in 12 countries

1266 patients (aged mean 61 years, 73% male) refractory unstable angina defined as: chest pain at rest with concomitant ECG abnormalities compatible with myocardial ischemia, and one or more episodes of typical chest pain, ECG abnormalities or both, compatible with myocardial ischemia during therapy with iv heparin and glycerol trinitrate, started at least 2 hours previously.

Excluded if
  • latest episode of ischaemia not within the 48 hours before enrolment
  • recent MI, unless creatine kinase values had returned to below two times the upper limit of normal
  • features of persisting ischaemia that would require immediate intervention
  • >50% occlusion of the left main coronary artery or a culprit lesion located in a bypass graft
  • bleeding risk factors such as surgery, gastrointestinal or genitourinary bleeding during the 6 weeks before enrolment, or a cerebrovascular accident within the previous 2 years
  • planned administration of oral anticoagulants, intravenous dextran or a thrombolytic agent before or during percutaneous transluminal coronary angioplasty
  • underlying medical conditions such as persistent hypertension despite treatment
  • history of haemorrhagic diathesis
  • history of autoimmune disease, or a platelet count below 100x10 9 /L


    • Control Group: (n = 636, 635 analysed): placebo
    Experimental Group: (n = 630, 630 analysed): abciximab , 0.25 mg/kg bolus followed by a continuous infusion of 10 µ g/min.
    Heparin was given from before randomisation until at least 1 hour after percutaneous transluminal coronary angioplasty procedure was performed. All patients received aspirin (minimum of 50 mg per day) and intravenous glyceryl trinitrate. Beta-blockers, calcium channel blockers and other cardiovascular drugs were allowed.
    99.9% followed for 6 months
    Outcome notes:
    • death, myocardial infarction or urgent intervention : intervention for treatment of recurrent ischaemia

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    death, myocardial infarction or urgent intervention 30 days 101
    (15.9%)    		 71
    (11.3%)    		 29.0%
    (6.00% to 47.0%)    		 4.64%
    (0.87% to 8.40%)    		 22
    (12 to 115)
    death, myocardial infarction or urgent intervention 6 months 193
    (30.4%)    		 193
    (30.6%)    		 -1.00%
    (-19.0% to 15.0%)    		 -0.24%
    (-5.32% to 4.83%)    		 -415
    (NNT = 21 to infinity;
    NNH = 19 to infinity)

    Citation

    1. The CAPTURE Investigators , : Randomised placebo-controlled trial of abciximab before and during coronary intervention in refractory unstable angina: the CAPTURE study. Lancet 1997; 349: 1429-1435
    Contributor: Clare Wotton and Bob Phillips, January 2000
    Reviewer: Dwight Peretz

    Clinical Question.
    Patient unstable angina
    Intervention or Exposure abciximab
    Comparison placebo
    Outcome death, infarction or urgent intervention