title: Long-term mortality benefit with abciximab in patients undergoing percutaneous coronary intervention.
abstract: OBJECTIVE
  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 reduces mortality after percutaneous coronary intervention (PCI); 2) if prevention of early myocardial infarction (MI) after PCI is a mechanism for reducing 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 consistently 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 comprising conventional therapy plus a bolus of abciximab within 1 h before PCI followed by a 12-h infusion; 4,136 controls were randomized to conventional therapy alone. Patient follow-up from six months to three years was available. 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 in mortality was estimated to be 0.5% through 30 days, 0.7% through six months, 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.
  
  
  CONCLUSIONS
  The evidence from 9,290 randomized PCI patients shows a mortality benefit provided by abciximab bolus plus 12-h infusion.
authors: Centocor, Malvern, Pennsylvania 19355-1307, USA. andersonk@centocor.com
authors: K M
authors: KM
authors: Anderson
authors: R M
authors: RM
authors: Califf
authors: G W
authors: GW
authors: Stone
authors: F J
authors: FJ
authors: Neumann
authors: G
authors: G
authors: Montalescot
authors: D P
authors: DP
authors: Miller
authors: J J
authors: JJ
authors: Ferguson
authors: J T
authors: JT
authors: Willerson
authors: H F
authors: HF
authors: Weisman
authors: E J
authors: EJ
authors: Topol
mesh_terms: D000077284:Abciximab; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D017225:Atherectomy, Coronary; D003327:Coronary Disease / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D016032:Randomized Controlled Trials as Topic; D015607:Stents; D016019:Survival Analysis
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077284:Abciximab