Glycoprotein IIb-IIIa inhibition with abciximab and postprocedural risk assessment: lessons from the evaluation of platelet IIb/IIIa inhibitor for stenting trial and implication for ad hoc use of glycoprotein IIb-IIIa antagonists.
BACKGROUND
Angiographic features of vessels in which stents have been deployed can be used to predict the risk of postprocedural ischemic events. The purpose of this study was to compare the effects of abciximab in patients with and without high-risk postprocedure features.


RESULTS
Protocol-mandated stent implantation was performed in 1586 patients in the Evaluation of Platelet IIb/IIIa Inhibitor for Stenting trial, 783 of whom received abciximab, and was successful in 97% of the patients. High-risk features were defined as the presence of Thrombolysis In Myocardial Infarction (TIMI) flow <3, presence of thrombus or major dissection, or residual stenosis >10%. The primary endpoint was a composite of death, myocardial infarction, and urgent target vessel revascularization at 30 days. High-risk features were present in 21% of the patients. In patients without high-risk features after stent placement, abciximab reduced the primary endpoint from 9.0% to 3.9% (P <.001) compared with 16.2% to 8.6% (P =.046) in patients in whom high-risk features were present. There was no statistical evidence of interaction between abciximab treatment and the presence or absence of high-risk features.


CONCLUSIONS
Glycoprotein IIb-IIIa antagonism with abciximab is equally effective in prevention of a composite of ischemic events in patients with and without high-risk features after stent placement. However, patients in whom high-risk features are present after stent placement are at increased risk of ischemic cardiac events even with abciximab treatment.
Mazur
Wojciech
W
Baylor College of Medicine and the Methodist Hospital, Houston, Tex, USA.
Kaluza
Grzegorz L
GL
Sapp
Shelly
S
Balog
Craig
C
Topol
Eric J
EJ
Mark
Daniel B
DB
Ellis
Stephen G
SG
Kereiakes
Dean J
DJ
Lincoff
A Michael
AM
Kleiman
Neal S
NS
D000077284:Abciximab; D000911:Antibodies, Monoclonal / Q000191:economics / Q000627:therapeutic use*; D003327:Coronary Disease / Q000191:economics / Q000401:mortality / Q000628:therapy*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000191:economics / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D018570:Risk Assessment; D015607:Stents / Q000191:economics
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077284:Abciximab