Long-term mortality benefit with abciximab in patients undergoing percutaneous coronary intervention

Objectives The goal of this study was to test: 1) if platelet glycoprotein IIb/IIIa (GP IIb/IIIa) blockade with abciximab bolus plus 12-h infusion red uces mortality after percutaneous coronary intervention (PCI); 2) if preven tion of early myocardial infarction (MI) after PCI is a mechanism for reduc ing mortality; and 3) for risk factors for mortality after PCI. Background Studies of PCI suggest that MI after intervention is predictive of mortality. Abciximab, a platelet GP IIb/IIIa receptor inhibitor, has con sistently reduced the incidence of MI among PCI patients in several trials. The presumed mechanism is prevention of platelet thrombus associated with vessel wall injury and downstream embolization into the microcirculation. Methods In eight trials, 5,154 patients were randomized to a regimen compri sing conventional therapy plus a bolus of abciximab within 1 h before PCI f ollowed by a 12-h infusion; 4,136 controls were randomized to conventional therapy alone. Patient follow-up from six months to three years was availab le. Survival differences are examined using proportional hazards regression and survival curves. Results A hazard ratio of 0.71 (95% confidence interval 0.57 to 0.89; p = 0 .003) suggests a mortality benefit with abciximab. The absolute reduction i n mortality was estimated to be 0.5% through 30 days, 0.7% through six mont hs, 0.9% through one year and 1.8% through three years. Early MI explained 18% of the observed mortality benefit at one year. Multivariate regression suggests that patients with advanced cardiovascular disease may derive the greatest mortality benefit from abciximab. Conclusion The evidence from 9,290 randomized PCI patients shows a mortalit y benefit provided by abciximab bolus plus 12-h infusion. (J Am Coll Cardio l 2001;37:2059-65) (C) 2001 by the American College of Cardiology.