Pronounced benefit of coronary stenting and adjunctive platelet glycoprotein IIb/IIIa inhibition in complex atherosclerotic lesions

Background-Previous trials testing stents compared with balloon angioplasty excluded patients with complex lesions and did not assess the effect of ad junctive platelet IIb/IIIa inhibition, This analysis sought to assess the e ffect of stenting and abciximab specifically for patients with complex lesi ons. Methods and Results-Patients with complex lesions (long, tandem, severely c alcified, restenotic, thrombotic, or ostial; total occlusions; bifurcations ; saphenous vein grafts; and multivessel interventions) from the Evaluation of PTCA to improve Long-Term Outcome by c7E3 GP IIb/IIIa Receptor Blockade (EPILOG) and the Evaluation of Platelet IIb/IIIa Inhibitor for Stenting (E PISTENT) trials were included in the analysis. The 1-year combined death or myocardial infarction rates in the 4 treatment groups were as follows: bal loon angioplasty/placebo, 14.2%; stent/placebo, 15.8%; balloon angioplasty/ abciximab, 7.6%; and stent/abciximab, 8.0% (P<0.001). Death rates were 3.2% , 3.1%, 2.1%, and 0.5%, respectively (P=0.03). The incidence of target vess el revascularization at 1 year was 30.5%, 18.0%, 24.4%, and 10.7% in the 4 groups, respectively (P<0.001). After adjustment for baseline differences, multivariate analysis demonstrated that the rate of death or myocardial inf arction was independently reduced by balloon angioplasty/abciximab (hazard ratio, 0.51; P<0.001) and stent/abciximab (hazard ratio, 0.60; P=0.02) but was not affected by the use of stents alone. Conversely, target vessel reva scularization was reduced by stent/placebo (hazard ratio, 0.53; P<0.001), s tent/abciximab (hazard ratio, 0.58; P<0.001), and balloon angioplasty/abcix imab (hazard ratio, 0.74; P=0.006) compared with balloon angioplasty/placeb o, respectively. Conclusions-The combination of stenting and abciximab during percutaneous c oronary interventions for patients with angiographically complex lesions co nfers additive long-term benefit with respect to death, myocardial infarcti on, and target vessel revascularization.