PLATELET GLYCOPROTEIN IIB IIA RECEPTOR BLOCKADE WITH ABCIXIMAB REDUCES ISCHEMIC COMPLICATIONS IN PATIENTS UNDERGOING DIRECTIONAL CORONARY ATHERECTOMY/

We determined the efficacy of abciximab, a platelet glycoprotein IIb/I IIa receptor antagonist, combined with low-dose weight-adjusted hepari n in reducing ischemic complications in patients undergoing directiona l coronary atherectomy (DCA). The Evaluation of IIb/IIIa platelet rece ptor antagonist 7E3 in Preventing Ischemic Complications (EPIC) trial demonstrated a reduction in the incidence of non-Q-wave myocardial inf arction in DCA patients who were treated with abciximab bolus and infu sion plus heparin. This benefit, however, was associated with increase d bleeding complications. Of the 2,792 patients who had coronary inter vention in the Evaluation of PTCA to Improve Long-term Outcome by c7E3 GP IIb/IIIa receptor blockade (EPILOG) trial, 144 (5%) underwent DCA. Patients were randomly assigned to 3 treatment groups: placebo with s tandard-dose, weight-adjusted heparin; abciximab with low-dose weight- adjusted heparin; or abciximab with standard-dose weight-adjusted hepa rin. Study end points included 30-day and 6-month composite incidence of death, myocardial infarction, or revascularization. Compared with t hose undergoing percutaneous transluminal coronary angioplasty (PTCA), DCA patients had a higher rate of myocardial infarction (11.1 % vs 4. 9%, p = 0.001) and predominantly non-Q-wave myocardial infarction (9.7 % vs 4.4%, p = 0.004). Abciximab was associated with a 57% lower combi ned rate of death, myocardial infarction, or urgent revascularization within 30 days following DCA (20% placebo vs 8.7% abciximab with low-d ose heparin) without excess risk of bleeding complications. A combined analysis of data from the EPIC and EPILOG trials demonstrates a reduc tion in the rate of death or myocardial infarction (19.9% vs 8.4%, p = 0.008) at 30 days that was sustained for up to 6 months in the abcixi mab-treated patients. These findings support the premise that non-Q-wa ve myocardial infarction in DCA patients are platelet mediated. (C) 19 98 by Excerpta Medica, Inc.