Complementary clinical benefits of coronary-artery stenting and blockade of platelet glycoprotein IIb/IIIa receptors

Background Inhibition of the platelet glycoprotein Ilb/IIIa receptor with t he monoclonal-antibody fragment abciximab reduces the acute ischemic compli cations associated with percutaneous coronary revascularization, whereas co ronary-stent implantation reduces restenosis. We conducted a trial to deter mine the efficacy of abciximab and stent implantation in improving long-ter m outcome. Methods A total of 2399 patients were randomly assigned to stent implantati on and placebo, stent implantation and abciximab, or balloon angioplasty an d abciximab. The patients were followed for six months. Results At six months, the incidence of the composite end point of death or myocardial infarction was 11.4 percent in the group that received ai stent and placebo, as compared with 5.6 percent in the group that received a ste nt and abciximab (hazard ratio, 0.47; 95 percent confidence interval, 0.33 to 0.68; P<0.001) and 7.8 percent in the group assigned to balloon angiopla sty and abciximab (hazard ratio, 0.67; 95 percent confidence interval, 0.49 to 0.92; P=0.01). The hazard ratio for stenting plus abciximab as compared with angioplasty plus abciximab was 0.70 (95 percent confidence interval, 0.48 to 1.04; P=0.07). The rate of repeated revascularization of the target vessel was 10.6 percent in the stent-plus-placebo group, as compared with 8.7 percent in the stent-plus-abciximab group (hazard ratio, 0.82; 95 perce nt confidence interval, 0.59 to 1.13; P=0.22) and 15.4 percent in the angio plasty-plus-abciximab group (hazard ratio, 1.49; 95 percent confidence inte rval, 1.13 to 1.97; P=0.005). The hazard ratio for stenting plus abciximab as compared with angioplasty plus abciximab was 0.55 (95 percent confidence interval, 0.41 to 0.74; P<0.001). Among patients with diabetes, the combin ation of abciximab and stenting was associated with a lower rate of repeate d target-vessel revascularization (8.1 percent) than was stenting and place bo (16.6 percent, P=0.02) or angioplasty and abciximab (18.4 percent, P=0.0 08). Conclusions For coronary revascularization, abciximab and stent implantatio n confer complementary long-term clinical benefits. (N Engl J Med 1999;341: 319-27.) (C) 1999. Massachusetts Medical Society.