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

Abstract

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 abciximab has not been fully elucidated. We assessed the clinical outcomes associated with rescue administration of abciximab during complex percutaneous coronary 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 coronary syndrome) treated with abciximab for thrombus-containing lesions, sub-optimal angioplasty results, procedural dissections or other complications. Stents were used in 73% of procedures. Procedural success was 97.0% and overall major in-hospital complication rate was 3.0% (death, 1.3%; Q-wave myocardial infarction, 0.7%; and emergent bypass surgery, 1.0%). Most frequent angiographic 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 5 times 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 revascularization (15.1%); cardiac event-free survival was 82.9%. We conclude that rescue administration of abciximab is associated with relatively low in-hospital complications and favorable long-term outcome in patients with sub-optimal 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.

• Authors: S Fuchs, R Kornowski, R Mehran, L Gruberg, L F Satler, A D Pichard, K M Kent, G W Stone, M B Leon
• Journal: The Journal of invasive cardiology (J Invasive Cardiol) Vol. 12 Issue 10 Pg. 497-501 (Oct 2000) ISSN: 1042-3931 [Print] United States
• PMID: 11022207 (Publication Type: Clinical Trial, Journal Article)

Chemical References

• Antibodies, Monoclonal
• Immunoglobulin Fab Fragments
• Platelet Aggregation Inhibitors
• Abciximab

Topics

• Abciximab
• Aged
• Angioplasty, Balloon, Coronary (adverse effects)
• Antibodies, Monoclonal (therapeutic use)
• Cohort Studies
• Emergency Treatment (methods)
• Female
• Follow-Up Studies
• Humans
• Immunoglobulin Fab Fragments (therapeutic use)
• Male
• Middle Aged
• Myocardial Infarction (mortality, therapy)
• Platelet Aggregation Inhibitors (therapeutic use)
• Survival Analysis
• Treatment Outcome