Clopidogrel plus abciximab reduced risk for adverse events better than clopidogrel when given to patients with acute coronary syndrome prior to percutaneous coronary interventions, according to a presentation at the annual meeting of the American College of Cardiology.

The ISAR-REACT 2 Trial evaluated whether addition of abciximab to pre-procedure clopidogrel (600 mg) and aspirin (500 mg) provided better prevention of post-procedural ischemic complications than clopidogrel-aspirin plus placebo. The European study randomized 2,022 patients with non?ST-segment elevation acute coronary syndrome to abciximab or placebo prior to undergoing percutaneous coronary intervention.

Adnan Kastrati, MD, of the Deutsches Herzzentrum, Munich, Germany and coinvestigators conducted the study from March 2003 through December 2005.
The primary end point of death, myocardial infarction, or urgent revascularization within 30 days after randomization was reached in 90 abciximab patients (8.9 percent) and 120 (11.9 percent) placebo patients, a 25-percent relative reduction of risk with abciximab. Most of the risk reduction caused by abciximab resulted from reduction in incidence of myocardial infarction and death.

There was no difference in the incidence of ischemic events between the abciximab group and the placebo group among patients without an elevated troponin level. However, among patients with an elevated troponin level, the incidence of ischemic events was significantly lower (29 percent reduced risk) in the abciximab group (13.1 percent) compared with the placebo group (18.3 percent). There were no significant differences between groups regarding risk of major or minor bleeding as well as need for transfusion.

“The benefits of abciximab appear to be confined to patients with an elevated troponin level,” the authors concluded.