on January 6, 2003
Published online before print January 6, 2003, doi: 10.1161/01.CIR.0000046487.06811.5E
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Submitted on July 15, 2002
From University Hospital Rotterdam (J.P.O., E.B., M.L.S.), Erasmus Medical Center, Rotterdam, the Netherlands; Division of Cardiology (P.A.), University of Alberta, Edmonton, Alberta, Canada; Centocor, Inc (E.S.B., J.S.C.), Malvern, Pa; Duke University Medical Center (E.M.O.), Durham, NC; Department of Cardiology (S.J., L.W.), Uppsala, Sweden; and The Cleveland Clinic Foundation (E.T.), Cleveland, Ohio. * To whom correspondence should be addressed. E-mail: Simoons{at}tch.fgg.eur.nl.
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.
Revised on September 27, 2002
Accepted on October 4, 2002
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
J. P. Ottervanger MD,
Key words: coronary disease • acute coronary syndromes • prognosis
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