Temporal spectrum of ischemic complications with percutaneous coronary intervention: the ESPRIT experience.
We determined the timing of ischemic complications within 30 days after percutaneous coronary intervention (PCI) in patients enrolled in the Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin Therapy (ESPRIT) trial. Complications (death, myocardial infarction [MI], target vessel revascularization) occurred in 178 of 2064 patients (8.6%) within 30 days. More than 85% of complications occurred within the 24 hours following randomization, with the greatest risk hazard at 12-18 hours. Unexpectedly, 31% of patients who ultimately met criteria for an endpoint MI within 24 hours of PCI had completely normal CK-MB concentrations at the first 6-hour measurement. There was no rebound increase in events after cessation of eptifibatide. Treatment benefit persisted to 30 days. Post-procedural MI is often not detected until greater than or equal to 12 hours after PCI. Treatment with a glycoprotein IIb/IIIa inhibitor is the only modifiable parameter that reduces the risk for early ischemic complications.
Cantor
Warren J
WJ
St. Michael's Hospital, Division of Cardiology, 30 Bond Street, Toronto, Ontario, Canada, M44-1W8. cantorw@smh.toronto.on.ca
Tcheng
James E
JE
Blankenship
James C
JC
O'Shea
J Conor
JC
Pieper
Karen S
KS
Criger
Douglas A
DA
Madan
Mina
M
Ducas
John
J
Sheldon
William S
WS
Tannenbaum
Mark A
MA
Smith
Jack E
JE
Kitt
Michael M
MM
Gilchrist
Ian C
IC
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D003402:Creatine Kinase / Q000032:analysis; D052279:Creatine Kinase, MB Form; D000077542:Eptifibatide; D005260:Female; D006801:Humans; D007527:Isoenzymes / Q000032:analysis; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control*; D017202:Myocardial Ischemia / Q000209:etiology* / Q000628:therapy; D010455:Peptides / Q000494:pharmacology / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D011183:Postoperative Complications; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D007527:Isoenzymes; D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form; D000077542:Eptifibatide