title: Pexelizumab reduces death and myocardial infarction in higher risk cardiac surgical patients.
abstract: BACKGROUND
  Morbidity and mortality after coronary artery bypass graft surgery are directly related to specific preoperative risk factors. We assessed the influence of preoperative risk factors on the effect of pexelizumab, a C5 complement inhibitor, to reduce postoperative morbidity and mortality in this post hoc analysis of the Pexelizumab for Reduction in Myocardial Infarction and MOrtality in Coronary Artery Bypass Graft surgery (PRIMO-CABG) trial, a phase III double-blind, placebo-controlled study of 3,099 patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass.
  
  
  METHODS
  The composite endpoint of death or myocardial infarction or both through postoperative day 30 was examined in subpopulations of patients with pre-specified risk factors, which included diabetes mellitus, prior coronary artery bypass graft, urgent intervention, female sex, history of neurologic event, history of congestive heart failure, and two or more previous myocardial infarctions or a recent myocardial infarction. Stratified post hoc analyses were also performed on patients presenting with two or more and three or more of those risk factors.
  
  
  RESULTS
  Pexelizumab significantly reduced the incidence of the composite endpoint of death or myocardial infarction through postoperative day 30 by 28% in patients with two or more risk factors (p = 0.004) and 44% in patients with three or more risk factors (p < 0.001).
  
  
  CONCLUSIONS
  The C5 complement inhibitor, pexelizumab, reduced morbidity and mortality among high-risk patients undergoing coronary artery bypass grafting with cardiopulmonary bypass.
authors.affiliation: Hannover Medical School, Hannover, Germany. haverich@thg.mh-hannover.de
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
authors.forename: Stanton K
authors.initials: SK
authors.lastname: Shernan
authors.forename: Jerrold H
authors.initials: JH
authors.lastname: Levy
authors.forename: John C
authors.initials: JC
authors.lastname: Chen
authors.forename: Michel
authors.initials: M
authors.lastname: Carrier
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Taylor
authors.forename: Frans
authors.initials: F
authors.lastname: Van de Werf
authors.forename: Mark F
authors.initials: MF
authors.lastname: Newman
authors.forename: Peter X
authors.initials: PX
authors.lastname: Adams
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Todaro
authors.forename: Michael
authors.initials: M
authors.lastname: van der Laan
authors.forename: Edward D
authors.initials: ED
authors.lastname: Verrier
mesh_terms: D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000517:prevention & control*; D057127:Single-Chain Antibodies
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D057127:Single-Chain Antibodies; C402724:pexelizumab