Reduction in periprocedural enzyme elevation by abciximab after rotationalatherectomy of type B-2 lesions: Results of the Rota ReoPro randomized trial

Background Abciximab has been shown to reduce ischemic complications and cr eatine kinase-myocardial bond (CKMB) elevation of both simple and complex c oronary interventions. In addition to the procedural complications, one of the important mechanisms for CK-MB elevation after rotational atherectomy i s an interaction between platelets and the atheromatous debris. Methods This study was conducted to determine whether abciximab would limit the extent of periprocedural CK-MB release after rotational atherectomy of American Heart Association/American College of Cardiology type B-2 lesions in a double-blind, randomized, placebo-controlled manner. A total of 100 l esions in 100 patients were randomized with the primary end point being a C K-MB elevation of > 16 U/L. Results Procedural success was achieved in 100% in the abciximab arm compar ed with 98% in the placebo group with any CK-MB elevation >16 U/L of 8% in the abciximab versus 22% in the placebo group (P = .04). The peak creatine phosphokinase level (units per liter) was 102 +/- 14 versus 153 +/- 22 (P = .05) and the peak CK-MB level was 12.8 +/- 1.8 versus 24.6 +/- 3.5 (P = .0 6) between the abciximab and placebo groups, respectively. Slow-flow or pos tprocedure chest pain occurred in 14% in the abciximab group versus 30% in the placebo group (P = .04). There was 1 Q-wave myocardial infarction in th e placebo arm and 1 nonhemorrhagic stroke in the abciximab group. Conclusions Therefore the Rota ReoPro randomized trial revealed the benefit of abciximab during rotational atherectomy in reducing procedural morbidit y and CK-MB elevation, and its routine use can be justified even in moderat ely complex lesions undergoing rotational atherectomy.