Evaluation of the role of abciximab (Reopro) as a rescue agent during percutaneous coronary interventions: In-hospital and six-month outcomes

Abciximab is effective for the prevention of complications when administere d prior to percutaneous coronary intervention (PCI). The efficacy and safet y of abciximab as an unplanned or rescue agent for complications of PCI is unknown. Rescue versus planned use was compared in 186 consecutive patients . Primary or rescue PCI for acute myocardial infarction (MI) and shock were excluded. Rescue abciximab use was undertaken in 101 patients (54.3%) and planned abciximab was used in 85 (45.7%). The rescue abciximab patients had a lower incidence of previous MI, preprocedural thrombus, multivessel, and vein graft intervention. In-hospital endpoints in the rescue versus planne d abciximab patients were death (1.0% vs. 1.2%, P = 1.0), Q-wave MI (2.0% v s. 2.4%, P = 1.0), any MI (14.9% vs. 9.4%, P = 0.3), target vessel revascul arization (TVR; 0% vs. 1.2%, P = 1.0), and composite (15.8% vs. 10.6%, P = 0.3). At 6 months, events were death (4.0% vs. 2.3%, P = 0.69), MI (14.9% v s. 9.4%, P = 0.26), TVR (20.8% vs. 4.7%, P = 0.001), and composite (30.7% v s. 15.3%, P = 0.01). In-hospital complications between the rescue and plann ed abciximab patients of major bleed (1.0% vs. 1.8%, P = NS), stroke (0% vs . 1.8%, P = NS), and thrombocytopenia (3.0% vs. 1.8%, P = NS) were similar. There was a significantly higher procedural time (99.6 min vs. 86.1 min, P = 0.02), contrast volume (278.8 ml vs. 223.5 ml, P = 0.04), and heparin us e (8984 u vs. 6003 u, P = 0.0006) in the rescue group. In this nonrandomize d comparison, rescue abciximab allowed for the safe discharge from hospital in the majority of patients. However, during a 6-month follow-up, more pat ients treated with rescue abciximab required TVR with either repeat PCI or CABG. Further studies are warranted to evaluate the overall strategy of res cue abciximab use in PCI. Cathet Cardiovasc. Intervent 51:138-144, 2000. 20 00 Wiley-Liss, Inc.