PCI with and without Abciximab after Upstream Eptifibatide Use: Outcomes in High-Risk Patients
- Volume 18 - Issue 12 - December, 2006
- Posted on: 8/1/08
- 1 Comments
- 4465 reads
Patients. Patients were eligible for the study if they had unstable angina: an episode of angina with an accelerating pattern, prolonged pain (> 20 minutes) or recurrent episodes of pain at rest or with minimal effort within the preceding 24 hours of hospital admission; non-ST-elevation myocardial infarction (NSTEMI): elevation of cardiac markers above institutional normal values in the absence of Q-waves; or STEMI: elevated cardiac markers and ST-elevation or new Q-waves. All patients in the study underwent PCI between 1999 and 2003. The control group consisted of patients who received upstream treatment with eptifibatide (180 mcg/kg bolus followed by 2.0 mcg/kg/minute intravenous drip) and heparin, and eptifibatide during PCI and for up to 18 hours post-PCI. The study group consisted of patients who also received eptifibatide (same dose as the control group) as upstream treatment for ACS, but who received abciximab during the PCI and for 12 hours post-PCI. Patients were not excluded from the study for any clinical reasons. The study was approved by the Institutional Review Board of Wake Forest University Baptist Medical Center.
Percutaneous revascularization procedure. Patients underwent percutaneous revascularization procedures, including atherectomy, using standard techniques. The choice of the type of PCI procedure was at the discretion of the interventionalist performing the procedure. No patient received drug-eluting stents, as they were not available during the study period. The method of arterial access site management was chosen by the interventionalist.12
Study medications. The choice of GP IIb/IIIa inhibitor to be used during the PCI was left to the discretion of the interventionalist. In general, the decision to use abciximab was made if high-risk patient (recent NSTEMI or STEMI), lesion (diffuse disease, multivessel disease, visible thrombus, bifurcation disease) or procedural (atherectomy) features were present. In those patients in whom abciximab was used, the eptifibatide infusion was stopped in the catheterization laboratory and abciximab was administered in standard fashion as a 0.25 mg/kg bolus followed by 0.125 µg/kg/minute (maximum 10 mcg/minute) intravenous infusion for 12 hours. In those patients in whom upstream treatment with eptifibatide was followed by eptifibatide administration during the PCI procedure, the eptifibatide infusion was continued at the same dose, with an additional bolus (180 mcg/kg) administered at the discretion of the interventionalist in 72% of patients. Heparin was administered as needed during the PCI procedure to maintain an activated clotting time between 200 and 250 seconds. No additional heparin was administered while the GP IIb/IIIa inhibitor was administered following the interventional procedure. All patients were pretreated with aspirin (325 mg) on admission and received aspirin on a daily basis thereafter. Ticlopidine 250 mg po bid or clopidogrel 300 mg po load followed by 75 po qd were given prior to or immediately after the procedure.