Myocardial infarction: coronary stenting plus abciximab reduced death, myocardial infarction and stroke compared with alteplase

Clinical bottom line (level 1b)

  1. Patients with a myocardial infarction who received coronary stenting and abciximab compared with thrombolysis with alteplase were less likely to die, have a myocardial infarction or a stroke (NNT = 7 at 6 months) .
  2. There was no clear difference in major haemorrhage between the two groups
Schomig et al: N Engl J Med 2000; 343 : 385-391
Expires February 2004

The study

Unblinded concealed randomised trial with intention-to-treat
Setting:

140 patients (aged median 59, 76% male) with an acute myocardial infarction (chest pain for at least 20 minutes, and ST-elevation of at least 0.1 mV in 2 contiguous leads)

Excluded if
  • history of a recent stroke
  • active bleeding or bleeding diathesis
  • trauma or surgery within previous month
  • suspected aortic dissection
  • noncompressible vascular punctures
  • on oral anticoagulation therapy with coumarin derivatives
  • severe uncontrolled hypertension (systolic bp > 180 mmHg unresponsive to therapy)
  • presented > 12 hours after symptom onset

Control Group: (n = 69, 69 analysed): intravenous thrombolysis with alteplase 15 mg followed by an infusion over 90 minutes: 0.75 mg/kg over 30 minutes, then 0.5 mg/kg over 60 minutes. All patients had heparin for 48 hours, and aspirin 100 mg indefinitely
Experimental Group: (n = 71, 71 analysed): coronary stenting plus abciximab 0.25 mg/kg bolus followed by a continuous infusion at 10 microgm per min for 12 hours.Patients received ticlopidine 250 mg twice daily for 4 weeks, and aspirin 100 mg daily indefinitely.
All patients received 500 mg aspirin and 5000 U heparin.
88% followed for 6 months

The evidence

Outcome Time to outcome CER EER RRR
(95% CI)		 ARR
(95% CI)		 NNT
(95% CI)
death, myocardial infarction or stroke 6 months 16
(23.2%)		 6
(8.45%)		 64%
(12% to 85%)		 14.7%
(2.86% to 26.6%)		 7
(4 to 35)
major bleeding 30 days 2
(2.90%)		 3
(4.23%)		 -46%
(-750% to 75%)		 -1.33%
(-7.46% to 4.80%)		 -75
(NNT = 21 to infinity;
NNH = 13 to infinity)

Comments

  1. The study is too small to show any difference in major haemorrhage between the two groups.

Citation

  1. Schomig A, Kastrati A, Dischinger J, et al: coronary stenting plus platelet glycoprotein IIb/IIIa blockade compared with tissue plasminogen activator in acute myocardial infarction. N Engl J Med 2000; 343 : 385-391
Search Terms: from ACP Journal Club
Contributor: Chris Ball, February 2002
Reviewer:

Clinical Question.
Patient myocardial infarction
Intervention or Exposure coronary stenting with abciximab
Comparison thrombolysis
Outcome death, myocardial infarction, stroke, major haemorrhage