Sustained suppression of ischemic complications of coronary intervention by platelet GP IIb/IIIa blockade with abciximab - One-year outcome in the EPILOG trial

Background-Blockade of the platelet glycoprotein IIb/IIIa receptor with the monoclonal antibody fragment abciximab was shown in a placebo-controlled r andomized trial to reduce the incidence of acute ischemic complications wit hin 30 days among a broad spectrum of patients undergoing percutaneous coro nary revascularization. The durability of clinical benefit in this setting has not been established. Methods and Results-A total of 2792 patients enrolled in the Evaluation in PTCA to Improve Long-term Outcome with abciximab GP IIb/IIIa blockade (EPIL OG) trial were followed with maintenance of double-blinding for 1 year. Pat ients had been assigned at the time of their index coronary interventional procedure to receive placebo with standard-dose, weight-adjusted heparin (1 00 U/kg initial bolus), abciximab with standard-dose, weight-adjusted hepar in, or abciximab with low-dose, weight-adjusted heparin (70 U/kg initial bo lus). The primary outcome was the composite of death, myocardial infarction , or urgent repeat revascularization by 30 days; this composite end point a nd its individual components were also assessed at 6 months and 1 year. Rat es of any repeat revascularization (urgent or elective), target Vessel reva scularization, and a composite of death, myocardial infarction, or any repe at revascularization were also reported. Follow-up at 1 year was 99% comple te for survival status and 97% complete for other end points. By 1 year, th e incidence of the primary composite end point was 16.1% in the placebo gro up, 9.6% in the abciximab with low-dose heparin group (P<0.001), and 9.5% i n the abciximab with standard-dose heparin group (P<0.001), Each of the com ponents of this composite end point was reduced to a similar extent, Nonurg ent or target vessel repeat revascularization rates were not significantly decreased by abciximab therapy, Mortality rates over 1 year increased with increasing levels of periprocedural creatine kinase MB fraction elevation. Conclusions-Acute reductions in ischemic events after percutaneous coronary intervention by abciximab are sustained over follow-up to at least 1 year. Early periprocedural myocardial infarctions suppressed by this therapy are associated with long-term mortality rates.