Previous studies have shown the benefit of using intravenous platelet glycoprotein IIb/IIIa inhibitors (abciximab) during percutaneous coronary revascularization. In the short term, there was a 38 percent reduction in the rates of postprocedure death and nonfatal myocardial infarction. Long-term benefit has been less well defined, however. Topol and associates conducted an analysis of three large, randomized trials that used abciximab to determine if all-cause mortality was reduced several years after this treatment.
The three trials analyzed by the authors were the Evaluation of c7E3 for the Prevention of Ischemic Complications (EPIC), Evaluation of PTCA to Improve Long-term Outcome by c7E3 GPIIb/IIIa receptor blockade (EPILOG), and Evaluation of IIb/IIIa Platelet Inhibitor for STENTing (EPISTENT). Patients who were undergoing percutaneous coronary revascularization were randomly assigned to receive placebo or abciximab. The follow-up period was three to nine years. If a patient could not be located, the National Death Index was searched, and patients not listed there were assumed to be alive at the end of the study period. The analysis compared all-cause mortality in patients receiving abciximab and patients receiving placebo. If there was no corresponding placebo group (e.g., in the EPISTENT group that had angioplasty plus abciximab), the patients were excluded.
The three-year "completeness rate" for all three studies was 96.6 percent. EPIC followed patients for seven years; 91.7 percent were tracked for the full period. The survival benefit for patients receiving abciximab was significant; the absolute difference in mortality was 1.4 percent (all-cause mortality was 6.4 percent in the placebo group and 5.0 percent in the abciximab group). There was a total of 652 deaths, 308 (12.6 percent) in the placebo groups compared with 344 (10.2 percent) in the abciximab groups. Of the various methods of abciximab administration, the greatest survival benefit occurred in patients who received a bolus dose of abciximab (as compared with a bolus dose plus subsequent infusion).
The authors conclude that abciximab confers short- and long-term survival benefits. Given the fact that there are at least 750,000 percutaneous coronary revascularization procedures every year, use of abciximab is associated with 11,000 fewer deaths annually. Specifically, this figure would equal 14 fewer deaths per 1,000 after three years and 21 fewer deaths per 1,000 after five years.
COPYRIGHT 2002 American Academy of Family Physicians
COPYRIGHT 2002 Gale Group
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