ABCIXIMAB ADMINISTRATION AND OUTCOME AFTER INTRACORONARY STENT IMPLANTATION

Although adjunctive abciximab therapy improves outcome after angioplas ty or atherectomy, there are few data demonstrating its benefit for in tracoronary stent implantation. We characterized patients receiving ab ciximab for stent placement in our practice and determined the impact of abciximab on outcome. Abciximab was introduced to our practice in A pril 1995 for percutaneous revascularization. Demographic, clinical, a nd angiographic variables that were independently associated with the use of abciximab for stent placement through 1996 (abciximab era) were examined, We then examined among all patients receiving stents from 1 992 through 1996 (preabciximab and abciximab eras) whether the use of abciximab was independently associated with improved outcome (death, n onfatal Q-wave myocardial infarction, coronary bypass surgery, or targ et vessel percutaneous revascularization) in the hospital and at 30 da ys. The 30-day event rate was 7% for those who did or did not receive abciximab. The following characteristics were independently associated with use of abciximab for stent placement in the abciximab era: throm bus before stent placement (chi-square 50.5), greater than or equal to 2 stents implanted (chi-square 10.8), stent in venous graft (chi-squa re 7.4), calcific lesion (chi-square 5.8), and hypertension (chi-squar e 5.5). Among all patients receiving stents in the preabciximab and ab ciximab eras (n = 1,859), the presence of these characteristics was in dependently associated with worse outcome. Abciximab, however, did not improve outcome in the hospital (odds ratio [95% confidence interval] = 0.96 [0.58 to 1.58]) or at 30 days (0.87 [0.53 to 1.41]), even afte r adjusting for these characteristics. Abciximab for stent placement w as used in high-risk patients in our practice but was not associated w ith improved outcome. (C) 1998 by Excerpta Medica, Inc.