EFFECT OF PLATELET GLYCOPROTEIN IIB IIIA RECEPTOR INHIBITION ON DISTAL EMBOLIZATION DURING PERCUTANEOUS REVASCULARIZATION OF AORTOCORONARY SAPHENOUS-VEIN GRAFTS/

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 limi ted by high rates of distal embolization, non-Q-wave acute myocardial infarction (AMI), and restenosis. Because these complications may be m ediated by platelets, inhibition of platelet glycoprotein Ilb/IIIa rec eptor, the final common pathway for aggregation, may improve clinical outcomes. In the Evaluation of IIb/IIIa platelet receptor antagonist 7 E3 in Preventing Ischemic Complications (EPIC) trial, 2,099 patients u ndergoing high-risk percutaneous coronary revascularization were rando mized to receive abciximab bolus and infusion, abciximab bolus followe d 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 infusi on therapy resulted in a significant reduction in distal embolization (2% vs 18%, p = 0.017) and a trend towards reduction in early large no n-Q-wave AMI (2% vs 12%, p = 0.165). The occurrence of a 30-day compos ite end point was similar among the 3 treatment groups. At 6 months, t here was also no difference in the composite end point These results s uggest that adjunctive therapy with abciximab during percutaneous trea tment of narrowed saphenous vein grafts reduces the occurrence of dist al embolization, and possibly non-Q-wave AMI. (C) 1997 by Excerpta Med ico, Inc.