Abciximab-facilitated percutaneous coronary intervention and long-term survival--a prospective single-center registry.
OBJECTIVE
To identify predictors of use of abciximab and evaluate the long-term survival after percutaneous coronary intervention with or without abciximab in a broad spectrum of patients.


METHODS
We prospectively evaluated, in a dedicated registry, the 4-year survival of patients undergoing percutaneous revascularization and the treatment with or without abciximab, using the Social Security Death Index.


RESULTS
Among 10,471 patients treated between 2/1/1995 and 12/31/2001, 5655 received abciximab and 4816 did not. Propensity score analysis (c-statistic 0.83) identified the following variables to be independently associated with abciximab use: later date of procedure, stent use, acute or recent infarction, increasing lesion complexity, vein graft intervention, hyperlipidemia, normal renal function, male gender and decreasing age. Procedural success was higher in the abciximab group, 93 vs. 89%, P<0.001. Unadjusted Kaplan-Meyer survival analysis demonstrated a strong trend for improved survival in the abciximab group at 4 years, 86.3 vs. 84.7%, P=0.09. In the 7533 patients with acute coronary syndromes (ACS), the respective values were 86.0 vs. 83.6%, P=0.03. Multivariate Cox proportional hazard analysis identified increasing age, significant left ventricular dysfunction or congestive heart failure, chronic renal insufficiency and diabetes mellitus as main predictors of mortality. Abciximab was independently associated with improved survival only in patients with ACS (adjusted HR 0.87, 95% confidence interval, 0.81-1.00, P=0.05). Abciximab use was associated with a higher rate of access site hematoma (2.8 vs. 1.5%) and blood product transfusion (6.8% vs. 4.8%), P<0.001 for both.


CONCLUSIONS
Abciximab use improves procedural success and is associated with lower 4-year mortality in patients with ACS, for whom it should be strongly considered. A lesser effect is seen in patients without high-risk characteristics.
Brener
Sorin J
SJ
Department of Cardiology, Cleveland Clinic Foundation, OH 44195, USA. breners@ccf.org
Ellis
Stephen G
SG
Schneider
Jakob
J
Apperson-Hansen
Carolyn
C
Topol
Eric J
EJ
D000077284:Abciximab; D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D003327:Coronary Disease / Q000150:complications / Q000401:mortality / Q000628:therapy*; D048909:Diabetes Complications; D005260:Female; D006333:Heart Failure / Q000150:complications; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000150:complications; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D015607:Stents; D016019:Survival Analysis; D018487:Ventricular Dysfunction, Left / Q000150:complications
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D000077284:Abciximab