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Effect of platelet glycoprotein IIb/IIIa receptor inhibition on distal embolization during percutaneous revascularization of aortocoronary saphenous vein grafts

Academic Article
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Overview

authors

  • Mak, K. H.
  • Challapalli, R.
  • Eisenberg, M. J.
  • Anderson, K. M.
  • Califf, R. M.
  • Topol, Eric

publication date

  • October 1997

journal

  • American Journal of Cardiology  Journal

abstract

  • Percutaneous treatment of narrowed aortocoronary saphenous vein graft disease represents a viable option for patients with recurrent angina following coronary artery bypass grafting. Present strategies are limited by high rates of distal embolization, non-Q-wave acute myocardial infarction (AMI), and restenosis. Because these complications may be mediated by platelets, inhibition of platelet glycoprotein IIb/IIIa receptor, the final common pathway for aggregation, may improve clinical outcomes. In the Evaluation of IIb/IIIa platelet receptor antagonist 7E3 in Preventing Ischemic Complications (EPIC) trial, 2,099 patients undergoing high-risk percutaneous coronary revascularization were randomized to receive abciximab bolus and infusion, abciximab bolus followed by placebo infusion or placebo. A total of 101 patients were treated for narrowing of saphenous vein grafts, 38 in the bolus and infusion group, 34 in the bolus group and 29 in the placebo group. Clinical end points included all-cause mortality, nonfatal AMI and need for repeat revascularization at 30 days. Compared with placebo, bolus and infusion therapy resulted in a significant reduction in distal embolization (2% vs 18%, p = 0.017) and a trend towards reduction in early large non-Q-wave AMI (2% vs 12%, p = 0.165). The occurrence of a 30-day composite end point was similar among the 3 treatment groups. At 6 months, there was also no difference in the composite end point. These results suggest that adjunctive therapy with abciximab during percutaneous treatment of narrowed saphenous vein grafts reduces the occurrence of distal embolization, and possibly non-Q-wave AMI.

subject areas

  • Aged
  • Angina, Unstable
  • Angioplasty, Balloon, Coronary
  • Antibodies, Monoclonal
  • Atherectomy, Coronary
  • Chemotherapy, Adjuvant
  • Coronary Artery Bypass
  • Coronary Disease
  • Embolism
  • Female
  • Graft Occlusion, Vascular
  • Humans
  • Immunoglobulin Fab Fragments
  • Male
  • Middle Aged
  • Myocardial Infarction
  • Platelet Aggregation Inhibitors
  • Platelet Glycoprotein GPIIb-IIIa Complex
  • Saphenous Vein
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Identity

International Standard Serial Number (ISSN)

  • 0002-9149

Digital Object Identifier (DOI)

  • 10.1016/s0002-9149(97)00589-4

PubMed ID

  • 9352964
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Additional Document Info

start page

  • 985

end page

  • 988

volume

  • 80

issue

  • 8

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