Impact of platelet glycoprotein IIb/IIIa Inhibition on the paclitaxel-eluting stent in patients with stable or unstable angina pectoris or provocable myocardial ischemia (a TAXUS IV substudy).
Whether the benefits that glycoprotein IIb/IIIa inhibitors confer in patients who undergo bare metal stent implantation extend to drug-eluting stents is unknown. We performed a prespecified subgroup analysis of the TAXUS IV study population to examine the effect of procedural glycoprotein IIb/IIIa inhibition during paclitaxel-eluting stent implantation on periprocedural creatine kinase-MB (CK-MB) levels. Glycoprotein (GP) IIb/IIIa inhibitors were administered to 57.7% of patients who had been randomized to receive the TAXUS stent and to 56.7% of those who had been randomized to receive the control stent. Among patients who received the TAXUS stent, the rate of CK-MB increases of >3 times the normal level was 2.6-fold higher in those who received a GP IIb/IIIa inhibitor than in those who did not (11.4% vs 4.4%, p = 0.0015). Composite rates of major adverse cardiac events and target vessel failure were also higher at 1 month in the GP IIb/IIIa group. By multivariate analysis, use of GP IIb/IIIa inhibitors during stenting with the TAXUS stent was an independent predictor of CK-MB increases >3 times the normal level. Further studies are warranted.
Teirstein
Paul S
PS
Scripps Clinic, La Jolla, California, USA. radman@scrippsclinic.com
Kao
John
J
Watkins
Matthew
M
Tannenbaum
Mark A
MA
Laufer
Nathan
N
Chang
Michael
M
Mehran
Roxana
R
Dangas
George
G
Russell
Mary E
ME
Ellis
Stephen G
SG
Stone
Gregg W
GW
D000077284:Abciximab; D000789:Angina, Unstable / Q000097:blood / Q000000981:diagnostic imaging / Q000628:therapy; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000972:Antineoplastic Agents, Phytogenic / Q000494:pharmacology*; D020099:Coated Materials, Biocompatible; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000517:prevention & control; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form; D004311:Double-Blind Method; D004347:Drug Interactions; D000077542:Eptifibatide; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D007527:Isoenzymes / Q000097:blood; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000628:therapy*; D009204:Myocardial Revascularization / Q000295:instrumentation*; D017239:Paclitaxel / Q000494:pharmacology*; D010455:Peptides / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors* / Q000378:metabolism; D015607:Stents; D000077466:Tirofiban; D016896:Treatment Outcome; D014443:Tyrosine / Q000031:analogs & derivatives / Q000627:therapeutic use
D000911:Antibodies, Monoclonal; D000972:Antineoplastic Agents, Phytogenic; D020099:Coated Materials, Biocompatible; D007140:Immunoglobulin Fab Fragments; D007527:Isoenzymes; D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D014443:Tyrosine; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form; D000077466:Tirofiban; D000077542:Eptifibatide; D017239:Paclitaxel; D000077284:Abciximab