Coronary artery disease
Meta-analysis of effectiveness and safety of abciximab versus eptifibatide or tirofiban in percutaneous coronary intervention

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Abstract

Three platelet glycoprotein (GP) IIb/IIIa receptor antagonists have been evaluated in patients undergoing percutaneous coronary intervention (PCI). One of these agents, abciximab, is structurally and pharmacologically quite different from the other 2, eptifibatide and tirofiban. We conducted a meta-analysis to determine whether different antagonist types achieved different clinical outcomes, possibly related to their structural differences. Odds ratios (OR) were calculated and a random effects model was used to combine the outcomes of 14,644 patients enrolled in 8 prospective, randomized, placebo-controlled clinical trials assessing treatment with a GP IIb/IIIa inhibitor to prevent ischemic complications of PCI. Neither abciximab (OR 0.69; 95% confidence interval [CI] 0.4 to 1.9) nor eptifibatide or tirofiban treatment (OR 0.74; 95% CI 0.4 to 1.28) resulted in reductions in mortality. Only the abciximab-treated patients had reductions in myocardial infarction (4.3% vs 8.5%, OR 0.49; 95% CI 0.40 to 0.59). There was no effect of eptifibatide or tirofiban on myocardial infarction (OR 0.85; 95% CI 0.69 to 1.04). Urgent revascularization was reduced in both abciximab-treated (2.7% vs 6.2%, OR 0.42; 95% CI 0.34 to 0.53) and eptifibatide- and tirofiban-treated (4.2% vs 5.5%, OR 0.76; 95% CI 0.60 to 0.96) groups. Only abciximab-treated patients had increased major bleeding (5.8% vs 3.8%; OR 1.53; 95% CI 1.24 to 1.90). There was no effect of eptifibatide or tirofiban on major bleeding (5.0% vs 4.3%; OR 1.19; 95% CI 0.94 to 1.52). Thus, significant differences exist between clinical outcomes achieved by abciximab and those achieved by eptifibatide or tirofiban following PCI procedures.

Section snippets

Data ascertainment

MEDLINE (National Library of Medicine, Bethesda, Maryland) was queried under the search headings platelet inhibitors, angioplasty, and stent to obtain relevant publications. In addition, references from pertinent review articles as well as abstracts were analyzed. Eight articles were selected for further analysis that reported 30-day outcomes of death, myocardial infarction (MI), urgent or emergent revascularization, and major bleeding after the use of a parenteral GP IIb/IIIa inhibitor in a

Baseline characteristics

The inclusion criteria for each trial, the interventional modalities used, and the GP IIb/IIIa inhibitor administered are shown in Table 1. In all, 8,876 patients were assigned to active treatment, whereas 5,768 received placebo. Of the patients administered a GP IIb/IIIa inhibitor, 5,022 (57%) received abciximab and 3,854 (43%) received a small molecule inhibitor. All patients received heparin and aspirin in addition to the GP IIb/IIIa inhibitor (or placebo). The duration of treatment before

Discussion

We have combined the data for mortality, MI, urgent revascularization, and major bleeding at 30 days from 8 prospective, randomized trials involving patients undergoing PCI comparing GP IIb/IIIa antagonists with placebo. The combined size of these studies is large enough to detect clinically relevant differences in rates of death, MI, urgent revascularization, and major bleeding relative to placebo for the 2 major categories of GP IIb/IIIa inhibitors: abciximab and the small molecule

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