Abciximab Therapy and Unplanned Coronary Stent Deployment

Abstract

Background-The clinical and angiographic demographics of patients requiring unplanned coronary stent deployment and the optimal adjunct pharmacotherapy in this population are not well described. This report details the EPILOG trial experience with unplanned coronary stent deployment and the effect of abciximab platelet glycoprotein IIb/IIIa blockade to improve clinical outcomes during 6 months of follow-up. Methods and Results-After randomization in the EPILOG double-blind, placebo-controlled trial of abciximab therapy during percutaneous coronary intervention, 326 (12%) of 2792 patients required unplanned coronary stent deployment. Although stented patients were not distinguished by clinical variables, they had greater coronary lesion complexity by American Heart Association/American College of Cardiology criteria (Pϭ.003) and greater incidence of lesion length Ͼ10 mm (Pϭ.002), lesion eccentricity (Pϭ.027), irregular lesion contour (Pϭ.001), and bifurcation involvement (Pϭ.019) than nonstented patients. Unplanned stents were required less often in patients treated with abciximab and low-dose, weight-adjusted heparin than in patients receiving placebo and standard-dose heparin (9.0% versus 13.7%; Pϭ.001). Although adverse clinical outcomes including target-vessel revascularization and bleeding events were more frequent in patients requiring unplanned coronary stent deployment, abciximab therapy reduced adverse outcomes in these patients at 30 days and 6 months to a greater extent than was observed in patients not requiring stent placement. Among stented patients, abciximab therapy did not increase bleeding events. Conclusions-Patients requiring unplanned coronary stent deployment have more complex coronary lesion morphology and a more complicated clinical course after coronary intervention. Abciximab therapy both reduces the need for unplanned stent deployment and confers clinical benefit to patients requiring an unplanned stent, without increasing bleeding complications. (Circulation. 1998;97:857-864.)

Prognostic Role of On-Line Vectorcardiography as Regards Repeat Revascularization after Successful Coronary Angioplasty

“…That stents improve long-term prognosis, such as preventing restenosis and revascularization, has previously been reported [31]. Still, recent studies have shown that stent implantation is related to more frequent CK elevation than plain balloon PTCA [32]. In this study, in the stent group, CK elevation was the only predictor of revascularization.…”

Abciximab Does Not Prevent Ischemic Lesions Related to Cerebral Angiography: A Randomized Placebo-Controlled Trial

“…Abciximab (ReoPro®) binds to the platelet glycoprotein IIb/IIIa receptor, which is the major platelet surface receptor involved in platelet aggregation. The effect of glycoprotein IIb/IIIa receptor blockade in the prevention of infarcts during coronary intervention is well established in the literature [7,8,9,10,11,12,13]. Current studies investigate the efficacy of glycoprotein IIb/IIIa inhibition in the acute phase of stroke [14].…”

Frontiers in Interventional Cardiology

“…32,33 As shown in Figure 2, in the Evaluation of PTCA to Improve Long-term Outcome by c7E3 GPIIb/IIIa Receptor Blockade (EPILOG) trial, Ͼ300 patients underwent stenting because of suboptimal balloon angioplasty results, and the benefit for IIb/IIIa inhibition with respect to reduction of MI and emergency revascularization was striking. 32 Of note, the favorable effects for combined IIb/IIIa inhibition (administered on a prophylactic basis) and stenting had thus far been shown only in patients with poor or suboptimal initial results. A dedicated trial (known as Evaluation of Platelet IIb/IIIa Inhibitor for Stenting [EPISTENT]) studied the use of IIb/IIIa blockade with elective stenting.…”

“…They first ion-implanted the nonradioactive element 31 P beneath the surface of the stent. The stents were then made radioactive by exposure to neutron irradiation, which converts a fraction of the 31 P atoms to 32 P, a pure ␤-particle emitter. This technique results in an even distribution of 32 P within the stent, which ensures homogeneous distribution of ␤-particle irradiation from the stent.…”

“…119 32 P, produced by neutron bombardment, was ionized and ion-implanted beneath the outer surface of titanium-nickel stents. 32 P has several characteristics.…”