Does platelet glycoprotein IIb/IIIa receptor antibody improve in-hospital outcome of coronary stenting in high-risk thrombus containing lesions?

Coronary stenting in acute coronary syndromes probably increases the risk o f acute stent thrombosis. Recently, use of platelet glycoprotein IIb/IIIa r eceptor antibody has been shown to improve percutaneous transluminal corona ry angioplasty (PTCA) outcomes in high risk lesions. The purpose of this an alysis was to determine safety and efficacy of platelet glycoprotein IIb/II Ia receptor antibody administration in patients receiving coronary stents i n high-risk lesions. Between October 1995 and November 1996, 282 patients w ith acute ischemic syndromes received coronary stents at our center: 73 had thrombus containing lesions-40 presented with AMI and 33 with unstable ang ina and make up the study population. The mean age of these patients was 61 +/- 13 years, 56 were male, 35 had a history of myocardial infarctions (MI ), 21 had prior coronary artery bypass graft (CABG), and 21 had prior PTCA. Coronary stenting was used for suboptimal result in 46 patients (63%), thr eatened closure in 25 patients (34%), and acute closure in 2 patients (3%). Platelet glycoprotein IIb/IIIa receptor antibody was administered during t he procedure in 74% and after the procedure in 26%. A total of 115 stents w ere deployed (Gianturco-Roubin 80, Palmaz-Schatz 29, and Wallstent 6) in 24 LAD, 21 RCA, 15 LCX, and 13 saphenous vein graft (SVG) lesions. Procedural success was 100%. The mean diameter stenosis before and after intervention was 60% +/- 31% and 4% +/- 14%, respectively. In-hospital events included 1 Q-wave MI (1.4%), 13 non-Q-wave MI (18%), and 1 death (1.4%). There was n o subacute stent thrombosis, emergency CABG, or repeat PICA. Significant in -hospital bleeding complications were noted in seven (10%) patients, with f ive patients (6.8%) requiring blood transfusions. In this series of patient s with acute ischemic syndromes associated with angiographic evidence of th rombus, combined use of platelet glycoprotein IIb/IIIa receptor antibody an d stenting resulted in a very low incidence of subacute stent thrombosis an d emergency target lesion revascularization, However, bleeding complication s were higher than expected with conventional antiplatelet therapy followin g routine stenting. (C) 1999 Wiley-Liss, Inc.