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Reduction in periprocedural enzyme elevation by abciximab after rotational atherectomy of type B2 lesions: Results of
1Zena and Michael A. Wiener Cardiovascular Institute, Mt Sinai Hospital, New York, NY 10029, USA.
Insights
Abciximab significantly reduced creatine kinase-myocardial band (CK-MB) elevation and procedural complications during rotational atherectomy. This study supports the routine use of abciximab for moderately complex coronary lesions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Abciximab is known to reduce ischemic complications and CK-MB elevation in coronary interventions.
- Platelet interaction with atheromatous debris contributes to CK-MB elevation post-rotational atherectomy.
Purpose of the Study:
- To evaluate the efficacy of abciximab in limiting periprocedural CK-MB release after rotational atherectomy.
- To assess the impact of abciximab on procedural complications in patients with type B(2) lesions.
Main Methods:
- A double-blind, randomized, placebo-controlled trial involving 100 patients undergoing rotational atherectomy.
- Patients were randomized to receive either abciximab or a placebo.
- The primary endpoint was CK-MB elevation exceeding 16 U/L.
Main Results:
- Abciximab use resulted in a significantly lower incidence of CK-MB elevation (>16 U/L) compared to placebo (8% vs. 22%, P=.04).
- Peak CK-MB levels were lower in the abciximab group (12.8 U/L vs. 24.6 U/L, P=.06).
- Abciximab reduced the occurrence of slow-flow or chest pain (14% vs. 30%, P=.04).
Conclusions:
- Abciximab demonstrated a significant benefit in reducing procedural morbidity and CK-MB elevation during rotational atherectomy.
- The routine use of abciximab is justified for moderately complex lesions undergoing rotational atherectomy.
Background:
Abciximab has been shown to reduce ischemic complications and creatine kinase-myocardial band (CK-MB) elevation of both simple and complex coronary interventions. In addition to the procedural complications, one of the important mechanisms for CK-MB elevation after rotational atherectomy is an interaction between platelets and the atheromatous debris.
Methods:
This study was conducted to determine whether abciximab would limit the extent of periprocedural CK-MB release after rotational atherectomy of American Heart Association/American College of Cardiology type B(2) lesions in a double-blind, randomized, placebo-controlled manner. A total of 100 lesions in 100 patients were randomized with the primary end point being a CK-MB elevation of >16 U/L.
Results:
Procedural success was achieved in 100% in the abciximab arm compared with 98% in the placebo group with any CK-MB elevation >16 U/L of 8% in the abciximab versus 22% in the placebo group (P =.04). The peak creatine phosphokinase level (units per liter) was 102 +/- 14 versus 153 +/- 22 (P =.05) and the peak CK-MB level was 12.8 +/- 1.8 versus 24.6 +/- 3.5 (P =.06) between the abciximab and placebo groups, respectively. Slow-flow or postprocedure chest pain occurred in 14% in the abciximab group versus 30% in the placebo group (P =.04). There was 1 Q-wave myocardial infarction in the placebo arm and 1 nonhemorrhagic stroke in the abciximab group.
Conclusions:
Therefore the Rota ReoPro randomized trial revealed the benefit of abciximab during rotational atherectomy in reducing procedural morbidity and CK-MB elevation, and its routine use can be justified even in moderately complex lesions undergoing rotational atherectomy.
