Long-Term Results After the Glycoprotein IIb/IIIa Inhibitor Abciximab in Unstable Angina
One-Year Survival in the GUSTO IV-ACS (Global Use of Strategies To Open Occluded Coronary Arteries IV - Acute Coronary Syndrome) Trial
BACKGROUND: This study was designed to investigate long-term effects of the glycoprotein IIb/IIIa inhibitor abciximab in patients with acute coronary syndrome without ST elevation who were not scheduled for coronary intervention. METHODS AND RESULTS: A total of 7800 patients were included with an acute coronary syndrome without ST elevation, documented by either elevated cardiac troponin or transient or persistent ST-segment depression. They were randomized to abciximab bolus and 24-hour infusion, abciximab bolus and 48-hour infusion, or matching placebo. The overall 1-year mortality rate was 8.3% (649 patients). One-year mortality was 7.8% in the placebo group and 8.2% in the 24-hour and 9.0% in the 48-hour abciximab infusion group. Compared with placebo, the hazard ratio for the 24-hour infusion of abciximab was 1.1 (95% CI 0.86 to 1.29), and for the 48-hour infusion, it was 1.2 (95% CI 0.95 to 1.41). The lack of benefit of abciximab was observed in every subgroup studied. Patients with negative troponin or elevated C-reactive protein had a higher mortality rate after treatment with abciximab for 48 hours than with placebo: 8.5% versus 5.8% in those with negative troponin (P=0.02), 16.3% versus 12.1% in those with elevated C-reactive protein (P=0.04). CONCLUSIONS: Compared with placebo, abciximab did not provide any survival benefit at 1 year in patients admitted with an acute coronary syndrome with ST depression and/or elevated troponin who were not scheduled to undergo early coronary revascularization. In subgroups of patients, in particular those with low cardiac troponin or elevated C-reactive protein, abciximab was associated with excess mortality.
|Keywords||Acute Disease, Adult, Aged, Angina, Unstable/diagnosis/*drug therapy/*mortality, Antibodies, Monoclonal/*therapeutic use, C-Reactive Protein/analysis, Comparative Study, Coronary Disease/diagnosis/drug therapy, Follow-Up Studies, Humans, Immunoglobulin Fab Fragments/*therapeutic use, Middle aged, Platelet Glycoprotein GPIIb-IIIa Complex/*antagonists & inhibitors, Research Support, Non-U.S. Gov't, Risk Factors, Survival Analysis, Syndrome, Treatment Outcome, Troponin/blood, acute coronary syndromes, coronary disease, prognosis|
|Persistent URL||dx.doi.org/10.1161/01.CIR.0000046487.06811.5E, hdl.handle.net/1765/10082|
Ottervanger, J.P., Barnathan, E.S., Cooper, J.S., Ohman, E.M., James, S.K., Topol, E.J., … Armstrong, P.W.. (2003). Long-Term Results After the Glycoprotein IIb/IIIa Inhibitor Abciximab in Unstable Angina. Circulation (Baltimore), 107(3), 437–442. doi:10.1161/01.CIR.0000046487.06811.5E