CLINICAL STUDIES
Reduction in complications of angioplasty with abciximab occurs largely independently of baseline lesion morphology
Stephen G. Ellis, MD*,
A. Michael Lincoff, MD*,
Dave Miller, MS ,
James E. Tcheng, MD ,
Neal S. Kleiman, MD ,
Dean Kereiakes, MD||,
Robert Califf, MD,
Eric J. Topol, MD* for the EPIC and EPILOG Investigators
* Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
Department of Biostatistics, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
Department of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
University of Texas, Houston, Texas, USA
|| The Christ Hospital, Cincinnati, Ohio, USA
Manuscript received March 17, 1998;
revised manuscript received July 7, 1998,
accepted July 24, 1998.
Address for correspondence: Dr. Stephen G. Ellis, The Cleveland Clinic Foundation, 9500 Euclid Avenue, F-25, Cleveland, Ohio 44195
elliss{at}cesmtp.ccf.org
Objectives. We investigated the hypothesis that abciximab might lead to a differential effect among patients with different lesion morphologies; hence, its cost/benefit ratio would be optimized if it were used selectively on the basis of baseline angiographic findings.
Background. Major complications of coronary angioplasty occur in 4% to 9% of patients. In the Evaluation of 7E3 for the Prevention of Ischemic Complications (EPIC) and Evaluation of PTCA To Improve Long-term Outcome with abciximab GPIIb/IIIa Receptor Blockade (EPILOG) trials, abciximab decreased the ischemic complications after intervention by 35% to 56%. However, the cost of this agent is appreciable, and there remain concerns about the safety of its readministration.
Methods. There were 1,362 patients in EPIC and 2,792 patients in EPILOG randomized to either bolus plus an infusion of abciximab or placebo, administered with aspirin and heparin at the time of the coronary intervention. Data from these studies were combined, and a differential effect of abciximab in relation to baseline lesion morphology on 30-day risk of death, myocardial infarction or urgent intervention was investigated using the Breslow Day test for statistical interaction.
Results. Abciximab consistently reduced the relative risk of complications across all lesion morphologies studied, with the possible exception of patients treated with degenerated saphenous vein grafts (risk with placebo 16.3% vs. risk with abciximab 18.6%, Breslow Day test for interaction, p = 0.08). However, the absolute reduction of risk was somewhat greater in patients with more complex B2 or C lesions (7.6% and 5.8%, respectively) than in patients with morphologically simpler A or B1 lesions (3.7% and 3.2%, respectively).
Conclusions. The reduction of early adverse ischemic events associated with angioplasty by abciximab occurs largely independent of pretreatment morphology.
|
Abbreviations and Acronyms
| | ACC/AHA | = American College of Cardiology/American Heart Association | | ACT | = activated clotting time | | EPIC | = Evaluation of 7E3 for the Prevention of Ischemic Complications (trial) | | EPILOG | = Evaluation of PTCA To Improve Long-term Outcome by c7E3 GPIIb/IIIa Receptor Blockade (trial) | | GP | = glycoprotein |
|
This article has been cited by other articles:
|
|
|
|
 
D. J. Kereiakes, M. A. Turco, J. Breall, N. Z. Farhat, R. L. Feldman, B. McLaurin, J. J. Popma, L. Mauri, P. Zimetbaum, J. Massaro, et al.
A Novel Filter-Based Distal Embolic Protection Device for Percutaneous Intervention of Saphenous Vein Graft Lesions: Results of the AMEthyst Randomized Controlled Trial
J. Am. Coll. Cardiol. Intv.,
June 1, 2008;
1(3):
248 - 257.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Mauri, C. Rogers, and D. S. Baim
Devices for Distal Protection During Percutaneous Coronary Revascularization
Circulation,
June 6, 2006;
113(22):
2651 - 2656.
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Okmen, A. Sanli, H. Uyarel, S. Dayi, Z. Tartan, and N. Cam
Impacts of Glycoprotein IIb/IIIa Inhibition on QT Dispersion After Successful Percutaneous Coronary Intervention
Angiology,
May 1, 2006;
57(3):
273 - 281.
[Abstract]
[PDF]
|
|
|
|
|
|
|
M. Jonas, G. W. Stone, R. Mehran, J. Hermiller, R. Feldman, H. C. Herrmann, D. A. Cox, R. E. Kuntz, J. J. Popma, C. Rogers, et al.
Platelet glycoprotein IIb/IIIa receptor inhibition as adjunctive treatment during saphenous vein graft stenting: differential effects after randomization to occlusion or filter-based embolic protection
Eur. Heart J.,
April 2, 2006;
27(8):
920 - 928.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Okmen, N. Cam, A. Sanli, S. Unal, Z. Tartan, and M. Vural
Cardiac Troponin I Increase After Successful Percutaneous Coronary Angioplasty: Predictors and Long-Term Prognostic Value
Angiology,
March 1, 2006;
57(2):
161 - 169.
[Abstract]
[PDF]
|
|
|
|
|
|
|
D. A. Gorog, R. A. Foale, and I. Malik
Distal Myocardial Protection During Percutaneous Coronary Intervention: When and Where?
J. Am. Coll. Cardiol.,
October 18, 2005;
46(8):
1434 - 1445.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R V Kelly and S Steinhubl
Changing roles of anticoagulant and antiplatelet treatment during percutaneous coronary intervention
Heart,
June 1, 2005;
91(suppl_3):
iii16 - iii19.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Rogers, R. Huynh, P. A. Seifert, B. Chevalier, J. Schofer, E. R. Edelman, G. Toegel, A. Kuchela, A. Woupio, R. E. Kuntz, et al.
Embolic Protection With Filtering or Occlusion Balloons During Saphenous Vein Graft Stenting Retrieves Identical Volumes and Sizes of Particulate Debris
Circulation,
April 13, 2004;
109(14):
1735 - 1740.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Schachinger, C. W. Hamm, T. Munzel, M. Haude, S. Baldus, E. Grube, T. Bonzel, T. Konorza, R. Koster, R. Arnold, et al.
A randomized trial of polytetrafluoroethylene-membrane-covered stents compared with conventional stents in aortocoronary saphenous vein grafts
J. Am. Coll. Cardiol.,
October 15, 2003;
42(8):
1360 - 1369.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. S. Baim
Percutaneous treatment of saphenous vein graft disease: The ongoing challenge
J. Am. Coll. Cardiol.,
October 15, 2003;
42(8):
1370 - 1372.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. J. Ross, H. C. Herrmann, D. J. Moliterno, J. C. Blankenship, L. Demopoulos, P. M. DiBattiste, S. G. Ellis, Z. Ghazzal, J. L. Martin, J. White, et al.
Angiographic variables predict increased riskfor adverse ischemic events after coronarystenting with glycoprotein IIb/IIIa inhibition: Results from the TARGET trial
J. Am. Coll. Cardiol.,
September 17, 2003;
42(6):
981 - 988.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. M. Lincoff and E. J. Topol
Glycoprotein IIb/IIIa Inhibition in Percutaneous Coronary Interventions--Reply
JAMA,
September 17, 2003;
290(11):
1451 - 1452.
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. E. Boden
"Routine invasive" versus "selective invasive" approaches to non-ST-segment elevation acute coronary syndromes management in the post-stent/platelet inhibition era
J. Am. Coll. Cardiol.,
February 19, 2003;
41(4_Suppl_S):
113S - 122S.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. W. LoGerfo, D. J. Drenth, N. J.G.M. Veeger, P. W. Boonstra, G. D'Ancona, H. Karamanoukian, R. E. Dragu, W. C. Wood, H. Thiele, F. W. Mohr, et al.
Minimally Invasive Bypass Surgery
N. Engl. J. Med.,
December 26, 2002;
347(26):
2165 - 2168.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Marzilli, G. Sambuceti, R. Testa, and S. Fedele
Platelet glycoprotein IIb/IIIa receptor blockade and coronary resistance in unstable angina
J. Am. Coll. Cardiol.,
December 18, 2002;
40(12):
2102 - 2109.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. J. Kereiakes
Platelet Glycoprotein IIb/IIIa Inhibition and Atheroembolism During Bypass Graft Angioplasty: A Cup Half Full
Circulation,
December 10, 2002;
106(24):
2994 - 2996.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Roffi, D. Mukherjee, D. P. Chew, D. L. Bhatt, L. Cho, M. A. Robbins, K. M. Ziada, D. M. Brennan, S. G. Ellis, and E. J. Topol
Lack of Benefit From Intravenous Platelet Glycoprotein IIb/IIIa Receptor Inhibition as Adjunctive Treatment for Percutaneous Interventions of Aortocoronary Bypass Grafts: A Pooled Analysis of Five Randomized Clinical Trials
Circulation,
December 10, 2002;
106(24):
3063 - 3067.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. W. Stone, C. Rogers, S. Ramee, C. White, R. E. Kuntz, J. J. Popma, J. George, S. Almany, and S. Bailey
Distal filter protection during saphenous vein graft stenting: Technical and clinical correlates of efficacy
J. Am. Coll. Cardiol.,
November 20, 2002;
40(10):
1882 - 1888.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J.-i. Kotani, S. Nanto, G. S. Mintz, M. Kitakaze, T. Ohara, T. Morozumi, S. Nagata, and M. Hori
Plaque Gruel of Atheromatous Coronary Lesion May Contribute to the No-Reflow Phenomenon in Patients With Acute Coronary Syndrome
Circulation,
September 24, 2002;
106(13):
1672 - 1677.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Singh, H. H. Ting, P. B. Berger, K. N. Garratt, D. R. Holmes Jr, and B. J. Gersh
Rationale for on-site cardiac surgery for primary angioplasty: a time for reappraisal
J. Am. Coll. Cardiol.,
June 19, 2002;
39(12):
1881 - 1889.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. S. Baim, D. Wahr, B. George, M. B. Leon, J. Greenberg, D. E. Cutlip, U. Kaya, J. J. Popma, K. K.L. Ho, and R. E. Kuntz
Randomized Trial of a Distal Embolic Protection Device During Percutaneous Intervention of Saphenous Vein Aorto-Coronary Bypass Grafts
Circulation,
March 19, 2002;
105(11):
1285 - 1290.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E Eeckhout and M.J Kern
The coronary no-reflow phenomenon: a review of mechanisms and therapies
Eur. Heart J.,
May 1, 2001;
22(9):
729 - 739.
[PDF]
|
|
|
|
|
|
|
J. J. Popma, E. M. Ohman, J. Weitz, A. M. Lincoff, R. A. Harrington, and P. Berger
Antithrombotic Therapy in Patients Undergoing Percutaneous Coronary Intervention
Chest,
January 1, 2001;
119
(2009):
321S - 336S.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. P. Chew and D. J. Moliterno
A critical appraisal of platelet glycoprotein IIb/IIIa inhibition
J. Am. Coll. Cardiol.,
December 1, 2000;
36(7):
2028 - 2035.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. L. Bhatt and E. J. Topol
Current Role of Platelet Glycoprotein IIb/IIIa Inhibitors in Acute Coronary Syndromes
JAMA,
September 27, 2000;
284(12):
1549 - 1558.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Choussat, A. J. R. Black, I. Bossi, T. Joseph, J. Fajadet, and J. Marco
Long-term clinical outcome after endoluminal reconstruction of diffusely degenerated saphenous vein grafts with less-shortening wallstents
J. Am. Coll. Cardiol.,
August 1, 2000;
36(2):
387 - 394.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Al Suwaidi, P. B. Berger, C. S. Rihal, K. N. Garratt, M. R. Bell, H. H. Ting, J. F. Bresnahan, D. E. Grill, and D. R. Holmes Jr.
Immediate and long-term outcome of intracoronary stent implantation for true bifurcation lesions
J. Am. Coll. Cardiol.,
March 15, 2000;
35(4):
929 - 936.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. W. Stone, B. R. Brodie, J. J. Griffin, L. Grines, J. Boura, W. W. O'Neill, C. L. Grines, and for the Second Primary Angioplasty in Myocardial I
Clinical and angiographic outcomes in patients with previous coronary artery bypass graft surgery treated with primary balloon angioplasty for acute myocardial infarction
J. Am. Coll. Cardiol.,
March 1, 2000;
35(3):
605 - 611.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Colombo
Different benefits, different risks, equal cost
Eur. Heart J.,
November 1, 1999;
20(21):
1531 - 1532.
[PDF]
|
|
|
|
|
|
|
M van den Brand, G.J Laarman, P.G Steg, I De Scheerder, G Heyndrickx, K Beatt, J Kootstra, and M.L Simoons
Assessment of coronary angiograms prior to and after treatment with abciximab, and the outcome of angioplasty in refractory unstable angina patients. Angiographic results from the CAPTURE trial
Eur. Heart J.,
November 1, 1999;
20(21):
1572 - 1578.
[Abstract]
[PDF]
|
|
|
|
|
|
|
C. Heeschen, M. J. van den Brand, C. W. Hamm, and M. L. Simoons
Angiographic Findings in Patients With Refractory Unstable Angina According to Troponin T Status
Circulation,
October 5, 1999;
100(14):
1509 - 1514.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Mathew, D. E. Grill, C. G. Scott, J. A. Grantham, H. H. Ting, K. N. Garratt, and D. R. Holmes Jr.
The influence of abciximab use on clinical outcome after aortocoronary vein graft interventions
J. Am. Coll. Cardiol.,
October 1, 1999;
34(4):
1163 - 1169.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
