Abstract 10069: Differential Mortality Effects with Short Term and Long Term Follow-up of Patients Following Glycoprotein 2b3a Inhibitor Administration in Patients with Stable and Unstable Coronary Artery Disease
Purpose: Glycoprotein 2b3a inhibitors are still commonly utilized in patients receiving coronary interventions for stable CAD and in patients who are suffering unstable coronary syndromes (ACS). Early reports suggested improved survival in PCI with use of these agents. There is little information available on whether this mortality benefit extends more than one month after administration. In this study, we sought to determine if there is a difference in early and late mortality with administration of G2b3a inhibitors in CAD and ACS.
Methods: A systematic review of the literature was performed to locate randomized controlled trials of G2b3a inhibitors in patients undergoing PCI and suffering acute coronary syndromes (STEMI and ACS). Studies were included if there were reports of both 30 day and 180-365 day death rates. Meta-analyses were performed for early (<30 day), late (30-365 day) and total (0-365 day) mortality separately for stable and unstable CAD. A separate analysis of abciximab in unstable CAD was also performed.
Results: Eighteen studies were identified: 7 for stable CAD (N=20868), 11 for ACS (N=62160), with abciximab utilized in 7 (N=48818). There were small, nonstatistically significant improvements in survival for use of G2b3a inhibitors in stable CAD (HR=0.84 early, 0.95 late, and 0.92 for the entire year). In contrast, there was no early benefit with use of G2b3a inhibitors in unstable CAD (HR=0.97). There was a statistically significant increase in mortality after 1 month (HR=1.13, CI 1.02-1.26) with their use. This effect was not changed when abciximab alone was evaluated.
Conclusion: Based on these trials, there is a late risk for mortality with administration of G2b3a inhibitors in patients with acute coronary syndromes with six of seven studies utilizing abciximab demonstrating increased late mortality. There was greater heterogeneity with the use of other agents.. There is no mortality benefit at 1 year with administration of G2b3a inhibitors in patients with stable CAD. These results demonstrate that late follow-up of even single dose drugs may be important. Further analysis of late effects of administration of all G2b3a inhibitors, especially in the setting of acute MI, is necessary.
- © 2011 by American Heart Association, Inc.