Related Experiment Videos
[Use of Abciximab in threatening vascular occlusion after PTCA]
H Mahrholdt1, K K Haase, A Baumbach
1Universität Tübingen Medizinische Klinik Abt. III.
Insights
Abciximab effectively manages acute vessel closure during percutaneous coronary intervention (PCI). This therapy restored blood flow in most patients, proving beneficial in bail-out situations post-PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- GP IIb/IIIa antagonists are effective in preventing myocardial infarction and cardiac death before percutaneous transluminal coronary angioplasty (PTCA).
- This study investigates abciximab's efficacy in managing threatened or acute vessel closure during PTCA.
Purpose of the Study:
- To determine the efficacy of abciximab as a bail-out therapy for acute or threatened vessel closure during PTCA.
Main Methods:
- Prospective study of 104 patients experiencing acute/threatened vessel closure during PTCA.
- Abciximab administered as a bolus (0.25 mg/kg) followed by infusion (10 µg/min for 12 hours).
- Repeat PTCA performed post-bolus, with sheath left in place for 24-hour angiography.
Main Results:
- TIMI flow III restored in 100/104 patients with abciximab and repeat PTCA.
- One-year follow-up showed major adverse cardiac events (MACE) in 15 patients (2 MI, 8 CABG, 5 RePTCA).
- In-hospital events occurred in 4 patients, with 3 requiring emergency CABG and succumbing to surgery.
Conclusions:
- Abciximab is effective in bail-out situations during or after PTCA.
- The use of abciximab in bail-out scenarios demonstrates clinical benefit.
- Further research is needed to compare bail-out abciximab with prophylactic administration.
Unlabelled:
The administration of GP IIb/IIIa antagonists has been shown to be effective in reducing myocardial infarction and cardial death when given before PTCA. This prospective study was performed to determine the efficacy of abciximab in a bail-out situation to manage threatened or acute vessel closure.
Methods:
Acute or threatened vessel closure was observed in 104 (5.5%) out of 1903 consecutive patients treated with PTCA in our institution. Of the 104 patients 46 (44%) were treated for unstable angina (CCS IV). Abciximab was administered in bail-out situations in a dosage of 0.25 mg/kg given as a bolus, which was followed by an intravenous infusion of 10 micrograms/min over 12 hours. Repeat PTCA was performed shortly after the administration of the abciximab bolus. After the procedure, the sheath was left in place and control angiography was carried out 24 h later.
Results:
In 100 of the 104 patients TIMI flow III could be restored by abciximab therapy and RePTCA. In 4 patients an additional stent implantation was necessary due to persistent flow limitation. One day post PTCA, early follow-up angiography demonstrated patency of all vessels except two. In-hospital events occurred in 4 patients. Three of these patients underwent emergency CABG due to subacute vessel closure a few hours after PTCA and died during or directly after surgery. Follow-up after one year included clinical status and control angiography of the target vessel. During long-term follow-up, MACE occurred in 15 patients (2 MI, 8 CABG and 5 RePTCA).
Conclusion:
The results of this prospective trial demonstrate the efficacy of abciximab therapy in bail-out situations occurring during or early after PTCA. The use of abciximab in bail-out situations appears clinically beneficial. Further studies have to compare the efficacy of this approach with prophylactic abciximab treatment.