Published Online
on April 21, 2009

A more recent version of this article appeared on June 1, 2009

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Original Article

A comparison of abciximab and small molecule glycoprotein IIb/IIIa inhibitors in patients undergoing primary percutaneous coronary intervention: a meta-analysis of contemporary randomized controlled trials.

Hitinder Gurm¹; Umesh Tamhane; Pascal Meier; P. Michael Grossman; Stanley J. Chetcuti and Eric R. Bates

University of Michigan Medical School, Ann Arbor, MI

¹ E-mail: hgurm{at}med.umich.edu

Background—Current guidelines recommend abciximab as the preferred agent for patients undergoing primary percutaneous coronary intervention (PCI), yet small molecule glycoprotein (GP) IIb/IIIa inhibitors are more commonly used in clinical practice. The objective of our meta- analysis was to evaluate for differences in clinical outcome between small molecule GP IIb/IIIa inhibitors and abciximab in ST elevation myocardial infarction (STEMI) patients undergoing primary PCI.

Methods and Results—Five randomized trials (n=2,138 patients) comparing tirofiban or eptifibatide with abciximab as an adjunctive therapy to primary PCI were included in this meta-analysis. Summary odds ratios for 30-day death, reinfarction and major bleeding were calculated using random effect and fixed-effects models. There were no differences in 30-day mortality (1.9 % for small molecule versus 2.3% for abciximab, OR 0.84, 95% CI 0.46- 1.55, P =0.58), reinfarction (1.3% versus 1.2%, OR 1.22 , 95% CI 0.51- 2.91, P = 0.69), or major bleeding (1.7% versus 1.3% OR 1.21, 95% CI 0.58-2.49, P =0.61) between the two adjunctive strategies. Similarly, there was no significant difference in the incidence of death (3.9% versus 5%, OR 0.77, 95% CI 0.41-1.46, P = 0.43) or reinfarction on follow up at 8 months between small molecule GP IIb/IIIa inhibitors and abciximab.

Conclusion—In patients undergoing primary PCI for STEMI, no difference in outcome could be identified in patients treated with small molecule GP IIb/IIIa inhibitor or abciximab.

Key Words: Primary PCI • ST elevation MI • abciximab • eptifibatide • tirofiban