Clinical outcomes following "rescue" administration of abciximab in patients undergoing percutaneous coronary angioplasty

Pre-intervention administration of abciximab in patients at "high risk" for coronary angioplasty has been shown to reduce acute and long-term cardiac outcomes. The role of intra-procedural ("rescue") administration of abcixim ab has not been fully elucidated. We assessed the clinical outcomes associa ted with rescue administration of abciximab during complex percutaneous cor onary interventions. We studied in-hospital and long-term (1-year) outcomes (death, myocardial infarction and target lesion revascularization) of 298 consecutive patients (78% male; age, 62 +/- 11 years; 83% with acute corona ry syndrome) treated with abciximab for thrombus-containing lesions, sub-op timal angioplasty results, procedural dissections or other complications. S tents were used in 73% of procedures. Procedural success was 97.0% and over all major in-hospital complication rate was 3.0% (death, 1.3%; Q-wave myoca rdial infarction, 0.7%; and emergent bypass surgery, 1.0%). Most frequent a ngiographic complications included visible thrombus (17%), dissections (17% ), threatened closure (7%), and distal embolization (7%). In-hospital non-Q wave myocardial infarction (defined as CK-MB greater than or equal to 5 ti mes normal) occurred in 31.0%. Out-of-hospital to one-year events included death (1.7%), Q-wave myocardial infarction (2.7%), and target lesion revasc ularization (15.1%); cardiac event-free survival was 82.9%. We conclude tha t rescue administration of abciximab is associated with relatively low in-h ospital complications and favorable longterm outcome in patients with sub-o ptimal angioplasty results and/or procedure-related complications, although peri-procedural non-Q wave myocardial infarction rate is high. A clinical and cost-effective comparison between provisional and rescue administration of abciximab may be warranted.