Assessment of coronary angiograms prior to and after treatment with abciximab, and the outcome of angioplasty in refractory unstable angina patients - Angiographic results from the CAPTURE trial

Background The CAPTURE study (c7E3 Anti Platelet Therapy in Unstable Refrac tory angina) was designed to assess outcome in patients with refractory ang ina undergoing angioplasty, receiving either abciximab or placebo. Methods One thousand two hundred and sixty-five patients with refractory un stable angina, defined as recurrent myocardial ischaemia despite medical tr eatment including heparin and nitrates were enrolled. After angiography, pa tients received an infusion of abciximab or placebo over 18-24 h preceding angioplasty, continuing until Ih after the procedure. In 1197 patients unde rgoing angioplasty the angiographic committee centrally reviewed the baseli ne as well as the procedural angiograms. Coronary flow and lesion character istics were assessed in the baseline angiogram as well as before interventi on. Angiographic outcome, reason for failure as well as complications were assessed after angioplasty. Results At 30 days follow-up, patients receiving abciximab (n=595) compared with placebo (n=602) had a 30% reduction in the composite primary end-poin t death, myocardial infarction or urgent (re)intervention: 10.8% vs 15.4% ( P=0.017). Baseline demographics were identical in the angiogram available g roup compared with the total study group. At 30 days, the non-angiogram ava ilable patients showed a higher incidence of events compared to those in wh om the angiogram was reviewed: 19.4 vs 13.1% (P=ns). Lesion characteristics and coronary flow were not different at baseline between the placebo and a bciximab groups. A primary end-point was reached in 9.6% of both placebo an d abciximab patients with type A or B-1 lesions, in 17.0% vs 12.0% with typ e B-2 lesions, and in 19.1% vs 11.5% with type >B-2 or C lesions. Sixty-one percent of placebo and abciximab patients had TIMI 3 flow at baseline angi ography. Pre-angioplasty TIMI 3 flow was observed in 69% and 72% respective ly. The thrombus was resolved between the angiograms in 22% and 43% respect ively, in the placebo and abciximab groups (P=0.033). Angiographic success of the procedure was achieved in 88% and 94% in the placebo and abciximab p atients, respectively (P<0.001). Stents were implanted in the ischaemia-rel ated artery in 56 and 60 patients, respectively. However, failure of the st ent procedure was more frequent in the placebo group than in the abciximab group, nine vs no patients (P=0.003). Conclusion More frequent thrombus resolution was observed and a higher angi ographic success rate was achieved in patients treated with abciximab befor e and during angioplasty compared with placebo. Patients with complex lesio ns as the underlying pathology reached fewer end-points if treated with abc iximab before and during angioplasty. (C) 1999 The European Society of Card iology.