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Prophylactic abciximab in elective coronary stenting: results of a randomized trial
Corrado Tamburino1, Giovanni Russo, Antonino Nicosia
1The Lindner Center for Research & Education, 2123 Auburn Avenue, Suite 424, Cincinnati, OH 45219, USA. lindner@fuse.net
Insights
Administering abciximab during complex coronary stent procedures is safe and effective. This treatment reduces in-hospital cardiac events and improves long-term outcomes, including lower restenosis rates.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Pharmacology
Background:
- Percutaneous coronary intervention (PCI) for complex lesions, especially long ones, carries higher risks.
- Long or overlapping stents are used for complex lesions but have high restenosis rates.
- Abciximab has shown promise in reducing adverse cardiac events in high-risk PCI patients.
Purpose of the Study:
- To evaluate the safety and efficacy of abciximab in patients undergoing elective implantation of long or multiple overlapping coronary stents.
- To determine the impact of abciximab on clinical and angiographic outcomes in this complex PCI setting.
Main Methods:
- A prospective, single-center randomized trial involving 107 patients.
- Patients received either standard heparin or abciximab with low-dose heparin.
- Outcomes assessed included bleeding, vascular complications, in-hospital cardiac events, target lesion revascularization, and angiographic restenosis.
Main Results:
- Abciximab use did not increase bleeding or vascular complications compared to standard heparin.
- A 68% reduction in composite in-hospital cardiac events was observed with abciximab.
- At 6 months, abciximab showed a 48% reduction in target lesion revascularization and decreased binary angiographic restenosis (p < 0.05).
Conclusions:
- Peri-procedural abciximab is safe and effective for complex PCI with long or overlapping stents.
- Abciximab reduces in-hospital adverse cardiac events and improves 6-month clinical and angiographic outcomes.
- This approach offers a favorable risk-benefit profile in a complex interventional cardiology setting.
Background:
The use of abciximab (c7E3 Fab; ReoPro , Eli Lilly & Company, Indianapolis, Indiana) during percutaneous coronary intervention (PCI) decreases the incidence of early (30-day) and late (6-month to 1 year) adverse cardiac ischemic events. In a high-risk population, abciximab also reduced the need for target lesion revascularization. PCI of lesions with complex morphology, particularly long lesions, is associated with more complicated outcomes. The use of multiple and/or long intracoronary stents to cover long coronary lesions may lower the incidence of acute or subacute occlusion, but is still limited by a high late restenosis rate. We characterized patients undergoing elective implantation of long or multiple overlapping coronary stents and determined the impact of abciximab administration on clinical and angiographic outcomes.
Methods And Results:
In a prospective, single-center randomized trial, a total of 107 patients undergoing elective implantation of long or multiple overlapping coronary stents were randomly assigned to receive either standard-dose heparin (n = 53) or abciximab plus low-dose heparin (n = 54). The use of abciximab was not associated with an increased incidence of bleeding or vascular complications compared to standard heparin regimen (3.7% versus 3.8%, respectively; p = NS). A 68% reduction in composite in-hospital cardiac events (i.e., death, myocardial infarction, urgent revascularization) was observed in the abciximab group (3.7% versus 11.5%, p = 0.1). At 6-month follow-up, a 48% reduction of target lesion revascularization (11% versus 21%; p = 0.1) and a decrease in binary angiographic restenosis were observed for abciximab-treated patients (17% versus 34%; p < 0.05).
Conclusion:
The peri-procedural use of abciximab during implantation of long or multiple overlapping coronary stents is safe and effective, as it does not increase bleeding or vascular complications compared to standard heparin anticoagulation and reduces the incidence of in-hospital adverse cardiac events; moreover, abciximab improves 6-month clinical and angiographic outcomes in such a complex setting.