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(Circulation. 2006;114:2040-2046.)
© 2006 American Heart Association, Inc.

Interventional Cardiology

Age-Dependent Effect of Abciximab in Patients With Acute Coronary Syndromes Treated With Percutaneous Coronary Interventions

Gjin Ndrepepa, MD; Adnan Kastrati, MD; Julinda Mehilli, MD; Franz-Josef Neumann, MD; Jurriën ten Berg, MD; Olga Bruskina, MD; Franz Dotzer, MD; Melchior Seyfarth, MD; Jürgen Pache, MD; Josef Dirschinger, MD; Kurt Ulm, PhD; Peter B. Berger, MD; Albert Schömig, MD

From Deutsches Herzzentrum (G.N., A.K., J.M., O.B., M.S., J.P., A.S.), Medizinische Klinik rechts der Isar (J.D., A.S.), and Institut für Medizinische Statistik und Epidemiologie (K.U.), Technische Universität, Munich, Germany; Herz-Zentrum (F.-J.N.), Bad Krozingen, Germany; St. Antonius Ziekenhuis (J.t.B.), Nieuwegein, Netherlands; Klinikum Garmisch-Partenkirchen (F.D.), Garmisch-Partenkirchen, Germany; and Geisinger Center for Health Research (P.B.B.), Danville, Pa.

Correspondence to Adnan Kastrati, MD, Deutsches Herzzentrum, Lazarettstrasse 36, 80636 München, Germany. E-mail kastrati{at}dhm.mhn.de

Received April 8, 2006; de novo received May 30, 2006; revision received June 17, 2006; accepted August 11, 2006.

Background— No studies have specifically performed an age-based analysis of the efficacy of abciximab in patients with non–ST-segment elevation acute coronary syndromes undergoing percutaneous coronary intervention (PCI). The aim of the study was to assess whether there are age-dependent differences in the clinical benefit of abciximab in patients with acute coronary syndrome treated with PCI.

Methods and Results— We performed this retrospective analysis of 2022 patients with acute coronary syndrome enrolled in the Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment (ISAR-REACT 2) study and randomized to receive abciximab or placebo during a PCI procedure. The incidence of major adverse cardiac events (MACE) during the 30 days after PCI was the primary end point of the study. On the basis of the cutoff age value provided by logistic regression in connection with bootstrap resampling, patients were divided into those younger (n=1220) and older (n=802) than 70 years. Among younger patients, the incidence of MACE was 7.7% in the abciximab group versus 13.3% in the placebo group (relative risk 0.57, 95% confidence interval 0.40 to 0.80, P=0.001). In contrast, no difference was observed among older patients: The incidence of MACE was 10.9% in the abciximab group versus 9.9% in the placebo group (relative risk 1.10, 95% confidence interval 0.72 to 1.69, P=0.65). After adjustment for other variables, including cardiac troponin, there was a significant interaction between age and abciximab (P=0.04) with respect to MACE reduction, with abciximab being more effective in younger patients.

Conclusions— In patients with non–ST-elevation acute coronary syndromes undergoing PCI, the efficacy of abciximab appears to be age-dependent, with greater benefit among younger patients.

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