Myocardial infarction: using abciximab during stenting reduced death, reinfarction and revascularisation

Clinical bottom line (level 1b)

  1. Patients with a myocardial infarction undergoing PTCA with stenting who received abciximab compared with placebo were less likely to die, reinfarct or require revascularisation (NNT = 9 at 6 months) , but were more likely to have a minor bleed (NNH = 11 at 6 months) .
Montalescot et al: N Engl J Med 2001; 344 : 1895-1903
Expires June 2004

The study

Double-blinded ?concealed randomised trial with intention-to-treat
Setting: 13 acute hospitals and 8 mobile cardiac catheterisation units, France

300 patients (aged mean 61, 82% male) with an acute myocardial infarction (ST elevation > 1 mm in 2 continguous leads) undergoing primary PTCA

Excluded if
  • symptoms began > 12 hours ago
  • limited life expectancy
  • child-bearing potential
  • known contraindication to therapy with aspirin, ticlopidine or heparin
  • aged < 18
  • bleeding diathesis
  • given thrombolytic agents for current MI
  • neoplasm
  • recent stroke
  • uncontrolled hypertension
  • recent surgery
  • oral anticoagulation therapy

Control Group: (n = 151, 151 analysed): stenting alone
Experimental Group: (n = 149, 149 analysed): stenting and abciximab 0.25 mg/kg bolus, followed by a 12-hour infusion of 0.125 microgm/kg/min (max 10 microgm/min)
All patients received heparin 70 U/kg bolus (max 7000 units), thena continuous infusion of 7U/kg/hr after PTCA for 24 hours, adjusted so aPTT 1.5 to 2.0. Patients received ticlopidine 250 mg twice daily for 30 days.
100% followed for 6 months

The evidence

Outcome Time to outcome CER EER RRR
(95% CI)		 ARR
(95% CI)		 NNT
(95% CI)
death, recurrent infarction or revascularisation 30 days 31
(20.5%)		 18
(12.1%)		 41%
(-0.46% to 66%)		 8.45%
(0.15% to 16.7%)		 12
(6 to 670)
death, recurrent infarction or revascularisation 6 months 51
(33.8%)		 34
(22.8%)		 32%
(2.2% to 53%)		 11.0%
(0.84% to 21.1%)		 9
(5 to 120)
minor bleeding 6 months 5
(3.31%)		 18
(12.1%)		 -270%
(-860% to -39%)		 -8.77%
(-14.7% to -2.81%)		 -11
(-36 to -7)

Comments

  1. 1 patient in the abciximab group had a major bleed compared with none in the placebo group.

Citation

  1. Montalescot G, Barragan P, Wittenberg O, et al: platelet glycoprotein IIb/IIIa inhibition with coronary stenting for acute myocardial infarction (ADMIRAL). N Engl J Med 2001; 344 : 1895-1903
Search Terms: from ACP Journal Club
Contributor: Chris Ball, June 2002
Reviewer:

Clinical Question.
Patient acute myocardial infarction
Intervention or Exposure PTCA with stenting and abciximab
Comparison PTCA with stenting and placebo
Outcome death, reinfarction, revascularisation, bleeding