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

• Published in: Circulation (New York, N.Y.) N.Y.), 2003-01, Vol.107 (3), p.437-442
• Main Authors: OTTERVANGER, J. P, ARMSTRONG, P, BARNATHAN, E. S, BOERSMA, E, COOPER, J. S, OHMAN, E. M, JAMES, S, TOPOL, E, WALLENTIN, L, SIMOONS, M. L
• Format: Article
• Language: English
• Subjects: Abciximab; Acute Disease; Adult; Aged; Angina, Unstable - diagnosis; Angina, Unstable - drug therapy; Angina, Unstable - mortality; Antianginal agents. Coronary vasodilator agents; Antibodies, Monoclonal - therapeutic use; Biological and medical sciences; C-Reactive Protein - analysis; Cardiovascular system; Coronary Disease - diagnosis; Coronary Disease - drug therapy; Follow-Up Studies; Humans; Immunoglobulin Fab Fragments - therapeutic use; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Platelet Glycoprotein GPIIb-IIIa Complex - antagonists & inhibitors; Risk Factors; Survival Analysis; Syndrome; Treatment Outcome; Troponin - blood
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.CIR.0000046487.06811.5E

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. 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). 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.