From The Carl and Edyth Lindner Center for Clinical Cardiovascular
Research (D.J.K.), University of Cincinnati, Cincinnati, Ohio; The Cleveland
Clinic Foundation (A.M.L., E.J.T.), Cleveland, Ohio; Ischemia Research &
Education Foundation (D.P.M.), San Francisco, Calif; Duke University Medical
Center (J.E.T., R.M.C.), Durham, NC; and Centocor, Inc (C.F.C., K.M.A.,
H.F.W.), Malvern, Pa.
Correspondence to Dean J. Kereiakes, MD, FACC, The Carl and Edyth Lindner Center for Clinical Cardiovascular Research, 2123 Auburn Ave, Suite 424, Cincinnati, OH 45219. E-mail lindner{at}healthall.com
Background—The clinical and
angiographic demographics of patients requiring unplanned
coronary stent deployment and the optimal adjunct
pharmacotherapy in this population are not well described. This report
details the EPILOG trial experience with unplanned coronary
stent deployment and the effect of abciximab platelet
glycoprotein IIb/IIIa blockade to improve clinical outcomes
during 6 months of follow-up.
Methods and Results—After randomization in the EPILOG
double-blind, placebo-controlled trial of abciximab therapy during
percutaneous coronary intervention, 326 (12%)
of 2792 patients required unplanned coronary stent deployment.
Although stented patients were not distinguished by clinical
variables, they had greater coronary lesion complexity by
American Heart Association/American College of
Cardiology criteria (P=.003) and greater
incidence of lesion length >10 mm (P=.002), lesion
eccentricity (P=.027), irregular lesion contour
(P=.001), and bifurcation involvement
(P=.019) than nonstented patients. Unplanned stents were
required less often in patients treated with abciximab and low-dose,
weight-adjusted heparin than in patients receiving placebo and
standard-dose heparin (9.0% versus 13.7%; P=.001).
Although adverse clinical outcomes including target-vessel
revascularization and bleeding events were more
frequent in patients requiring unplanned coronary stent
deployment, abciximab therapy reduced adverse outcomes in these
patients at 30 days and 6 months to a greater extent than was observed
in patients not requiring stent placement. Among stented patients,
abciximab therapy did not increase bleeding events.
Conclusions—Patients requiring unplanned coronary stent
deployment have more complex coronary lesion morphology and a
more complicated clinical course after coronary intervention.
Abciximab therapy both reduces the need for unplanned stent deployment
and confers clinical benefit to patients requiring an unplanned stent,
without increasing bleeding complications.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Abciximab Therapy and Unplanned Coronary Stent Deployment
Favorable Effects on Stent Use, Clinical Outcomes, and Bleeding Complications
Key Words: stents • platelets • glycoproteins • abciximab
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