Glycoprotein IIb/IIIa receptor inhibition with abciximab during percutaneous coronary interventions increases the risk of bleeding in patients with impaired renal function.
OBJECTIVE
Whether patients with renal insufficiency (RI) undergoing percutaneous coronary interventions (PCI) benefit from abciximab added to clopidogrel plus aspirin is unknown.


METHODS
The study included 2,159 patients with coronary artery disease undergoing elective PCI. RI was assessed using glomerular filtration rate (GFR) cutoff values: moderate-to-severe RI (GFR <or=60 ml/min), mild RI (GFR >60 to <or=90 ml/min) and no RI (GFR >90 ml/min). The 30-day incidence of major adverse cardiac events (MACE) and bleeding were the primary outcome analyses.


RESULTS
In patients with moderate-to-severe RI, mild RI and no RI, MACE occurred in 5.2, 5 and 2.9%, respectively, in the abciximab group (p = 0.14) and in 4.2, 3.8 and 4.0%, respectively, in the placebo group (p = 0.96). In the abciximab group, bleeding complications occurred in 8.9% of patients with moderate-to-severe RI, in 2.0% with mild RI and in 2.1% with no RI (p < 0.001). Multivariable analysis identified GFR as an independent correlate of MACE (p = 0.03) and bleeding (p = 0.001) with a trend for an interaction between GFR and abciximab regarding major bleeding (p = 0.22).


CONCLUSIONS
In patients with RI undergoing PCI, adding abciximab to clopidogrel plus aspirin increases the risk of bleeding without benefit in reducing the risk of ischemic complications within the first 30 days.
Pinkau
Tobias
T
Deutsches Herzzentrum und Medizinische Klinik rechts der Isar, Technische Universitat und Medizinische Abteilung fur Nieren- und Hochdruckerkrankungen, Stadtisches Krankenhaus Munchen-Schwabing, Munchen, Deutschland.
Ndrepepa
Gjin
G
Kastrati
Adnan
A
Mann
Johannes F E
JF
Schulz
Stefanie
S
Mehilli
Julinda
J
Schömig
Albert
A
D000077284:Abciximab; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects*; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D004359:Drug Therapy, Combination; D005260:Female; D005858:Germany; D005919:Glomerular Filtration Rate; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D051437:Renal Insufficiency / Q000150:complications* / Q000401:mortality; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin; D000077284:Abciximab