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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Benefits From Small Molecule Administration as Compared With Abciximab Among Patients With ST-Segment Elevation Myocardial Infarction Treated With Primary Angioplasty

A Meta-Analysis

Division of Cardiology, "Maggiore della Carità" Hospital, Eastern Piedmont University "A. Avogadro," Novara, Italy

Manuscript received October 30, 2008; revised manuscript received December 17, 2008, accepted January 7, 2009.

^_* Reprint requests and correspondence: Dr. Giuseppe De Luca, Chief, Interventional Cardiology, "Maggiore della Carità" Hospital, Eastern Piedmont University "A. Avogadro," Novara, Italy (Email: giuseppe.deluca{at}maggioreosp.novara.it).

Objectives: The aim of the study was to perform a meta-analysis of randomized trials (RTs) comparing abciximab versus small molecules (eptifibatide and tirofiban) in primary angioplasty (PPCI) for ST-segment elevation myocardial infarction (STEMI).

Background: Abciximab has been shown to provide significant benefits in PPCI for STEMI. However, small molecules represent an attractive strategy due to the reversibility of the inhibition of platelet aggregation and the lower costs.

Methods: We obtained results from RTs comparing abciximab versus small molecules in PPCI. The literature was scanned by searches of electronic databases (MEDLINE and CENTRAL) up to October 2008. The following key words were used: RT, myocardial infarction, reperfusion, primary angioplasty, glycoprotein IIb/IIIa inhibitors, abciximab, tirofiban, and eptifibatide. Concerning tirofiban, we only included trials or groups of patients with high-dose bolus and infusion. The primary end point was 30-day mortality. Secondary end points were 30-day reinfarction, post-procedural Thrombolysis In Myocardial Infarction (TIMI) flow grade 3, and ST-segment resolution.

Results: A total of 6 RTs were included in the meta-analysis, involving 2,197 patients (1,082 randomized to abciximab and 1,115 to small molecules [high-dose tirofiban in 5 trials and eptifibatide in 1 trial]). Abciximab did not improve post-procedural TIMI flow grade 3 (89.8% vs. 89.1%, p = 0.72) or ST-segment resolution (67.8% vs. 68.2%, p = 0.66). Abciximab did not reduce 30-day mortality (2.2% vs. 2.0%, p = 0.66) or reinfarction (1.2% vs. 1.2%, p = 0.88), nor was there any difference in major bleeding complications (1.3% vs. 1.9%, p = 0.27).

Conclusions: This meta-analysis shows among STEMI patients undergoing PPCI similar results between abciximab and small molecules in terms of angiographic, electrocardiographic, and clinical outcome.

Key Words: primary angioplasty • meta-analysis • abciximab • STEMI • small molecules

Abbreviations and Acronyms   CI = confidence interval   GP = glycoprotein   OR = odds ratio   phet = p heterogeneity   STEMI = ST-segment elevation myocardial infarction   TIMI = Thrombolysis In Myocardial Infarction

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