Document Detail

Effect of platelet glycoprotein IIb/IIIa receptor inhibition on distal embolization during percutaneous revascularization of aortocoronary saphenous vein grafts. EPIC Investigators. Evaluation of IIb/IIIa platelet receptor antagonist 7E3 in Preventing Ischemic Complications.
MedLine Citation:
PMID:  9352964     Owner:  NLM     Status:  MEDLINE    
Percutaneous treatment of narrowed aortocoronary saphenous vein graft disease represents a viable option for patients with recurrent angina following coronary artery bypass grafting. Present strategies are limited by high rates of distal embolization, non-Q-wave acute myocardial infarction (AMI), and restenosis. Because these complications may be mediated by platelets, inhibition of platelet glycoprotein IIb/IIIa receptor, the final common pathway for aggregation, may improve clinical outcomes. In the Evaluation of IIb/IIIa platelet receptor antagonist 7E3 in Preventing Ischemic Complications (EPIC) trial, 2,099 patients undergoing high-risk percutaneous coronary revascularization were randomized to receive abciximab bolus and infusion, abciximab bolus followed by placebo infusion or placebo. A total of 101 patients were treated for narrowing of saphenous vein grafts, 38 in the bolus and infusion group, 34 in the bolus group and 29 in the placebo group. Clinical end points included all-cause mortality, nonfatal AMI and need for repeat revascularization at 30 days. Compared with placebo, bolus and infusion therapy resulted in a significant reduction in distal embolization (2% vs 18%, p = 0.017) and a trend towards reduction in early large non-Q-wave AMI (2% vs 12%, p = 0.165). The occurrence of a 30-day composite end point was similar among the 3 treatment groups. At 6 months, there was also no difference in the composite end point. These results suggest that adjunctive therapy with abciximab during percutaneous treatment of narrowed saphenous vein grafts reduces the occurrence of distal embolization, and possibly non-Q-wave AMI.
K H Mak; R Challapalli; M J Eisenberg; K M Anderson; R M Califf; E J Topol
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial    
Journal Detail:
Title:  The American journal of cardiology     Volume:  80     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  1997 Oct 
Date Detail:
Created Date:  1997-11-28     Completed Date:  1997-11-28     Revised Date:  2013-05-24    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  985-8     Citation Subset:  AIM; IM    
Department of Cardiology, The Cleveland Clinic Foundation, Ohio 44195, USA.
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MeSH Terms
Angina, Unstable / prevention & control
Angioplasty, Balloon, Coronary*
Antibodies, Monoclonal / administration & dosage,  therapeutic use*
Atherectomy, Coronary / methods
Chemotherapy, Adjuvant
Coronary Artery Bypass / adverse effects*
Coronary Disease / prevention & control
Embolism / prevention & control
Graft Occlusion, Vascular / therapy*
Immunoglobulin Fab Fragments / administration & dosage,  therapeutic use*
Middle Aged
Myocardial Infarction / prevention & control
Platelet Aggregation Inhibitors / therapeutic use*
Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors*
Saphenous Vein / transplantation
Reg. No./Substance:
0/Antibodies, Monoclonal; 0/Immunoglobulin Fab Fragments; 0/Platelet Aggregation Inhibitors; 0/Platelet Glycoprotein GPIIb-IIIa Complex; X85G7936GV/abciximab

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