Principal Findings:

The 30-day mortality in the standard-dose reteplase and half-dose reteplase plus abciximab was similar (5.9% vs. 5.6%, odds ratio [OR] 0.95, confidence interval [CI] 0.83-1.08, p=0.43). The composite of death or nonfatal reinfarction was lower for the combination than for reteplase alone (OR 0.83, CI 0.74-0.93, p=0.0011). The recurrent MIs were mostly made up of ischmemic ST segment changes as determined by the unblinded investigator. The need for urgent revascularization was lower for the combination therapy. Contrariwise, non-intracranial bleeding complications occurred with greater frequency in the combination group (severe or moderate bleeding OR 2.03, CI 1.70-2.42; p<0.0001). While overall rates of ICH were the same between the 2 regimens, the rate of ICH in patients over the age of 75 was increased in the combination therapy arm (2.1% vs 1.1%, p<0.05 for the interaction term).

For patients with STEMI, combined reteplase and abciximab was non-inferior (although not superior) to standard reteplase for decreasing the 30-day mortality. The beneficial effects of combination therapy over standard reteplase on secondary complications, were partially offset by a doubling of the rate of non-intracranial bleeding with this regimen, and by a higher risk of ICH in patients over the age of 75.