REDUCTION OF RECURRENT ISCHEMIA WITH ABCIXIMAB DURING CONTINUOUS ECG-ISCHEMIA MONITORING IN PATIENTS WITH UNSTABLE ANGINA REFRACTORY TO STANDARD TREATMENT (CAPTURE)

Background-In the CAPTURE (c7E3 Fab Anti Platelet Therapy in Unstable REfractory angina) trial, 1265 patients with refractory unstable angin a were treated with abciximab or placebo, in addition to standard trea tment from 16 to 24 hours preceding coronary intervention through 1 ho ur after intervention. To investigate the incidence of recurrent ische mia and the ischemic burden, a subset of 332 patients (26%) underwent continuous vector-derived 12-lead ECG-ischemia monitoring, Methods and Results-Patients were monitored from start of treatment through 6 hou rs after coronary intervention. Ischemic episodes were detected in 31 (18%) of the 169 abciximab and in 37 (23%) of the 163 placebo patients (NS). Only 9 (5%) of abciximab versus 22 (14%) of placebo patients ha d greater than or equal to 2 ST episodes (P<0.01), In patients with is chemia, abciximab significantly reduced total ischemic burden (P<0.02) , which was calculated alternatively as the total duration of ST episo des per patient, the area under the curve of the ST vector magnitude d uring episodes, or the sum of the areas under the curves of 12 leads d uring episodes. Twenty-one patients (6%) suffered a myocardial infarct ion (MI) (18) or died (3) within 5 days of treatment. The presence of asymptomatic and symptomatic ST episodes during the monitoring period preceding coronary intervention was associated with an increased relat ive risk of these events of 3.2 (95% CI 1.4, 7.4) and 4.1 (95% CI 1.4, 12.2), respectively. Conclusions-Recurrent ischemia predicts MI or de ath within 5 days of follow-up. Treatment with abciximab is associated with a reduction of frequent ischemia and a reduction of total ischem ic burden in patients with refractory unstable angina. As such, patien ts with ischemia derive particularly high benefit from abciximab.