***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES We sought to evaluate the efficacy of abciximab as adjunctive therapy to routine infa rct -related artery ( IRA ) stenting . BACKGROUND The impact of abciximab on the efficacy of myocardial reperfusion and the outcome of patients with acute myocardial infa rct ion ( AMI ) undergoing IRA stenting have not yet been defined . METHODS In a r and omized trial , we assigned 400 patients with AMI to undergo IRA stenting alone or stenting plus abciximab . The primary end point was a composite of death , reinfa rct ion , target vessel revascularization ( TVR ) , and stroke at one month . RESULTS The incidence of the primary end point was lower in the abciximab group than in the stent only group ( 4.5 % and 10.5 % , respectively ; p = 0.023 ) , and r and omization to abciximab was independently related to the risk of the primary end point ( odds ratio 0.41 , 95 % confidence interval 0.17 to 0.97 ; p = 0.041 ) . Early ST-segment resolution was more frequent in the abciximab group ( 85 % vs. 68 % , p < 0.001 ) . Infa rct size , as assessed by one-month technetium-99 m sestamibi scintigraphy , revealed smaller infa rcts in the abciximab group . At six months , the cumulative difference in mortality between the groups increased ( 4.5 % vs. 8 % ) , and the incidence of the composite of six-month death and reinfa rct ion was lower in the abciximab group than in the stent only group ( 5.5 % and 13.5 % , respectively ; p = 0.006 ) . Six-month repeat TVR and restenosis rates were similar in the two groups . CONCLUSIONS Abciximab plus IRA stenting should be considered the routine reperfusion strategy in patients with AMI undergoing primary percutaneous mechanical revascularization , especially in high-risk patients Background —The impact on survival of routine use of abciximab as adjunctive treatment to routine infa rct artery stenting for acute myocardial infa rct ion is not defined . We sought to determine the effect of abciximab on 1-year survival and other major adverse cardiac events of patients with acute myocardial infa rct ion undergoing routine infa rct artery stenting . Methods and Results —The Abciximab and Carbostent Evaluation ( ACE ) Trial is an unblinded , r and omized , controlled trial that compared abciximab with placebo in patients undergoing routine infa rct artery stent implantation for acute myocardial infa rct ion . At 1 year , the survival rate was 95±2 % in the abciximab group and 88±2 % in the stent-alone group ( P = 0.017 ) . The reinfa rct ion rate was 1 % in the abciximab group and 6.0 % in the stent-alone group , whereas there were no differences between groups in target vessel revascularization rate ( 16.5 % in the abciximab group , 17.5 % in the stent-alone group ) . Conclusions —Abciximab as adjunctive treatment to routine infa rct artery stenting for acute myocardial infa rct ion result ed in improved 1-year survival and lower reinfa rct ion rates BACKGROUND When administered in conjunction with primary coronary stenting for the treatment of acute myocardial infa rct ion , a platelet glycoprotein IIb/IIIa inhibitor may provide additional clinical benefit , but data on this combination therapy are limited . METHODS We r and omly assigned 300 patients with acute myocardial infa rct ion in a double-blind fashion either to abciximab plus stenting  ( 149 patients ) or placebo plus stenting ( 151 patients ) before they underwent coronary angiography .  Clinical outcomes were evaluated 30 days and 6 months after the procedure . The angiographic patency of the infa rct -related vessel and the left ventricular ejection fraction were evaluated at 24 hours and 6 months . RESULTS At 30 days , the primary end point -- a composite of death , reinfa rct ion , or urgent revascularization of the target vessel -- had occurred in 6.0 percent of the patients in the abciximab group , as compared with 14.6 percent of those in the placebo group ( P=0.01 ) ; at 6 months , the corresponding figures were 7.4 percent and 15.9 percent ( P=0.02 ) . The better clinical outcomes in the abciximab group were related to the greater frequency of grade 3 coronary flow ( according to the classification of the Thrombolysis in Myocardial Infa rct ion trial ) in this group than in the placebo group before the procedure ( 16.8 percent vs. 5.4 percent , P=0.01 ) , immediately afterward ( 95.1 percent vs. 86.7 percent , P=0.04 ) , and six months afterward ( 94.3 percent vs. 82.8 percent , P=0.04 ) . One major bleeding event occurred in the abciximab group ( 0.7 percent ) ; none occurred in the placebo group . CONCLUSIONS As compared with placebo , early administration of abciximab in patients with acute myocardial infa rct ion improves coronary patency before stenting , the success rate of the stenting procedure , the rate of coronary patency at six months , left ventricular function , and clinical outcomes BACKGROUND The combination of glycoprotein IIb/IIIa inhibitors and heparin has not been compared with bivalirudin in studies specifically involving patients with non-ST-segment elevation myocardial infa rct ion undergoing percutaneous coronary intervention ( PCI ) . We compared the two treatments in this patient population . METHODS Immediately before PCI , we r and omly assigned , in a double-blind manner , 1721 patients with acute non-ST-segment elevation myocardial infa rct ion to receive abciximab plus unfractionated heparin ( 861 patients ) or bivalirudin ( 860 patients ) . The study tested the hypothesis that abciximab and heparin would be superior to bivalirudin with respect to the primary composite end point of death , large recurrent myocardial infa rct ion , urgent target-vessel revascularization , or major bleeding within 30 days . Secondary end points included the composite of death , any recurrent myocardial infa rct ion , or urgent target-vessel revascularization ( efficacy end point ) and major bleeding ( safety end point ) within 30 days . RESULTS The primary end point occurred in 10.9 % of the patients in the abciximab group ( 94 patients ) and in 11.0 % in the bivalirudin group ( 95 patients ) ( relative risk with abciximab , 0.99 ; 95 % confidence interval [ CI ] , 0.74 to 1.32 ; P=0.94 ) . Death , any recurrent myocardial infa rct ion , or urgent target-vessel revascularization occurred in 12.8 % of the patients in the abciximab group ( 110 patients ) and in 13.4 % in the bivalirudin group ( 115 patients ) ( relative risk , 0.96 ; 95 % CI , 0.74 to 1.25 ; P=0.76 ) . Major bleeding occurred in 4.6 % of the patients in the abciximab group ( 40 patients ) as compared with 2.6 % in the bivalirudin group ( 22 patients ) ( relative risk , 1.84 ; 95 % CI , 1.10 to 3.07 ; P=0.02 ) . CONCLUSIONS Abciximab and unfractionated heparin , as compared with bivalirudin , failed to reduce the rate of the primary end point and increased the risk of bleeding among patients with non-ST-segment elevation myocardial infa rct ion who were undergoing PCI . ( Funded by Nycomed Pharma and others ; ISAR-REACT 4 Clinical Trials.gov number , NCT00373451 . ) Background Subgroup analyses of trials enrolling acute coronary syndrome patients suggest that inhibition of glycoprotein IIb/IIIa can improve the outcome of diabetic patients undergoing percutaneous coronary interventions ( PCIs ) , possibly by improving microvascular perfusion . However , the efficacy of small-molecule IIb/IIIa receptor inhibitors to improve microvascular perfusion in stable diabetic patients undergoing elective PCI has not been specifically investigated . Methods We r and omized consecutive stable diabetic patients , undergoing elective PCI , to tirofiban or placebo groups along with double antiplatelet therapy . High-dose bolus ( 25 μg/kg per 3 min ) of tirofiban was administered immediately before PCI followed by 8 h continuous infusion ( 0.15 μg/kg per min ) . Postprocedural myonecrosis was assessed prospect ively by measurement of cardiac troponin T ( cTnT ) at 6 and 24 h after PCI . The primary end-points were post-PCI coronary flow estimated by corrected thrombolysis in myocardial infa rct ion frame count and post-PCI myocardial infa rct ion . Platelet aggregation was measured by platelet function analyser-100 values . Results Forty-six patients entered the study ( 22 r and omized to placebo and 24 r and omized to tirofiban )  . The study drug was associated with a significant increase of platelet function analyser-100 values that peaked immediately after PCI and was maintained at 6 h ( pre-PCI : 131 ± 65 s ; post-PCI : 222 ± 49 s ; after 6 h : 219 ± 55 s ) . Post-PCI corrected thrombolysis in myocardial infa rct ion frame count was similar in tirofiban and in placebo groups ( 10.2 ± 3.6 vs. 12.0 ± 7.6 , P = 0.30 , respectively ) . The prevalence of raised cTnT levels was similar in the two groups ( 25 vs. 30 % , P = 0.56 , respectively ) . At multivariate analysis , direct stenting ( associated with reduced myonecrosis ) and postdilatation ( associated with increased myonecrosis ) predicted cTnT elevation . Conclusion A high-dose bolus of tirofiban in stable diabetic patients undergoing elective PCI , along with double antiplatelet therapy , was associated with a significant further inhibition of platelet aggregation which , however , did not translate in a lower incidence of post-PCI distal embolization In this pilot study , we show that periprocedural administration of tirofiban during stenting of critically stenosed saphenous vein grafts , significantly reduces the occurrence of postprocedural minor myocardial necroses INTRODUCTION Glycoprotein IIb/IIIa inhibitors such as tirofiban inhibit platelet aggregation . We evaluated the immediate and early outcomes in patients with high-risk non-ST elevation acute coronary syndrome ( NSTE ACS ) who received tirofiban with conventional therapy  compared to patients who received only conventional therapy ( a combination of aspirin , clopidogrel , low-molecular-weight heparin with or without beta-blockers and angiotensin-converting enzyme inhibitors ) . METHODS A total of 165 patients received conventional therapy with a placebo  , and 136 patients received conventional therapy with tirofiban after r and omisation . The outcomes were measured on Day 7 , Day 14 , one month and three months after the administration of therapy . RESULTS A significant reduction was noted in the occurrence of primary endpoints in patients receiving tirofiban , compared to those who received a placebo at seven days ( 14 versus 32 ; p-value is 0.036 ) , 14 days ( 14 versus 28 ; p-value is 0.043 ) , one month ( 19 versus 34 ; p-value is 0.01 ) and three months ( 30 versus 44 ; p-value is less than 0.001 ) after administration . There was a significant reduction in the occurrence of fatal myocardial infa rct ion ( MI ) ( 1 versus 8 ; p-value is 0.044 ) and non-fatal MI at Day 7 ( 1 versus 8 ; p-value is 0.044 ) , and refractory ischaemia at the end of one month ( 14 versus 24 ; p-value is 0.04 ) and three months ( 25 versus 36 ; p-value is less than 0.01 ) in patients receiving tirofiban as compared to those receiving a placebo . CONCLUSION It may be concluded that tirofiban has a definite role in improving the outcome of patients with high-risk NSTE ACS CONTEXT Previous studies indicate that industry-sponsored trials tend to draw proindustry conclusions . OBJECTIVE To explore whether the association between funding and conclusions in r and omized drug trials reflects treatment effects or adverse events . DESIGN Observational study of 370 r and omized drug trials included in meta-analyses from Cochrane review s selected from the Cochrane Library , May 2001 . From a r and om sample of 167 Cochrane review s , 25 contained eligible meta-analyses ( ass 
    Output:
    
When administered during PCI , intravenous glycoprotein IIb/IIIa blockers reduce the risk of all-cause death at 30 days but not at six months , and reduce the risk of death or myocardial infa rct ion at 30 days and at six months , at a price of an increase in the risk of severe bleeding .
The efficacy effects are homogeneous but are less marked in patients pre-treated with clopidogrel  where they seem to be effective only in patients with acute coronary syndromes .
When administered as initial medical treatment in patients with NSTEACS , these agents do not reduce mortality although they slightly reduce the risk of death or myocardial infa rct ion