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(Circulation. 2002;106:2994.)
© 2002 American Heart Association, Inc.

Editorial

Platelet Glycoprotein IIb/IIIa Inhibition and Atheroembolism During Bypass Graft Angioplasty

A Cup Half Full

Dean J. Kereiakes, MD

From the Lindner Clinical Trial Center and Ohio Heart Health Center, Cincinnati, Ohio.

Correspondence to Dean J. Kereiakes, MD, The Lindner Center for Research and Education, 2123 Auburn Ave, Suite 424, Cincinnati, OH 45219. E-mail lindner@fuse.net

Key Words: Editorials • glycoproteins • embolism • angioplasty

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Adjunctive platelet glycoprotein (GP) IIb/IIIa receptor inhibition during percutaneous coronary intervention (PCI) reduces the incidence of periprocedural major adverse cardiovascular events and improves long-term clinical outcomes.¹ The specific administration of abciximab has been associated with a long-term (1 to 3 years) survival advantage^2,3 that seems to be proportional to the preprocedural clinical risk profile of the patient.⁴ Initial reports that abciximab administration during PCI for surgical bypass grafts reduced the incidence of distal embolization and improved late clinical outcomes were embraced enthusiastically by interventional cardiologists because of the problematic nature of PCI in this complex subset of patients.^5,6

See p 3063

Compared with native coronary vessel PCI, surgical bypass graft intervention is associated with an increased frequency of periprocedural myocardial infarction, as well as an increased incidence of recurrent ischemia, repeat revascularization, and mortality in late follow-up.⁷ Indeed, multivariable analysis demonstrates a history of prior coronary bypass graft surgery to be an independent correlate of mortality to 3 years after PCI,⁴ which likely reflects the more generalized burden of atherosclerotic disease process in this population. Despite the initial enthusiasm for adjunctive platelet GP IIb/IIIa blockade during bypass graft PCI, subsequent reports have questioned the effectiveness of this strategy.^8,9 The article by Roffi et al¹⁰ in the current issue of Circulation confirms and extends the knowledge base on adjunctive pharmacotherapy during bypass graft PCI and fits nicely into our current framework of understanding provided by parallel evolution in concepts regarding the pathophysiology of atheroembolization and the benefit provided for nonpharmacological mechanical . . . [Full Text of this Article]

Related Article:

Lack of Benefit From Intravenous Platelet Glycoprotein IIb/IIIa Receptor Inhibition as Adjunctive Treatment for Percutaneous Interventions of Aortocoronary Bypass Grafts: A Pooled Analysis of Five Randomized Clinical Trials

Marco Roffi, Debabrata Mukherjee, Derek P. Chew, Deepak L. Bhatt, Leslie Cho, Mark A. Robbins, Khaled M. Ziada, Danielle M. Brennan, Stephen G. Ellis, and Eric J. Topol
Circulation 2002 106: 3063-3067. [Abstract] [Full Text]

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