| Feasibility and implications of an early discharge strategy after percutaneous intervention with abciximab in acute myocardial infarction (the CADILLAC Trial). | |
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MedLine Citation:
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PMID: 14516875 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Early complications may hamper efforts to hasten discharge after primary percutaneous coronary intervention (PCI) for myocardial infarction (MI). Glycoprotein IIb/IIIa inhibitors, by reducing early recurrent ischemia, may aid in these efforts. We examined whether adjunctive abciximab could accelerate discharge and reduce costs within a trial of primary PCI after acute MI. The CADILLAC trial randomized 2,082 patients with MI to 1 of 4 reperfusion strategies in a 2 x 2 factorial design: angioplasty, angioplasty with abciximab, stent implantation, or stenting with abciximab. Patients randomized to abciximab had postprocedural heparin withheld, and discharge scheduled for days 1.5 to 2 (low-risk patients) or days 2 to 3 (high-risk patients) after MI if they were stable. Other patients were discharged at the physician's discretion. Abciximab treatment was associated with significant reductions in the primary end points of in-hospital death, reinfarction, ischemic target vessel revascularization (TVR), or disabling stroke (5.6% vs 2.7%, p = 0.003)--largely reflecting reduced ischemic TVR (3.8% vs 1.4%, p = 0.002)--and in early subacute thrombosis (1.3% vs 0.2%, p = 0.01). Hospitalization was significantly shorter in abciximab-treated patients (median 3.1 vs 3.5 days, p <0.001), but total in-hospital costs did not differ significantly (13,413 +/- 5,309 US dollars vs 13,000 +/- 6,006 US dollars, p = 0.13). Rates of the composite end point did not differ significantly during the week after discharge (0.8% vs 0.2%, p = 0.10), nor did component event rates. Abciximab during primary PCI is associated with fewer early adverse outcomes, likely contributing to offset its cost. Hospitalizations after primary PCI are so short, however, that efforts to accelerate discharge with abciximab appear unfeasible, and overall costs remain unchanged. |
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Authors:
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David E Kandzari; James E Tcheng; David J Cohen; Ameet Bakhai; Cindy L Grines; David A Cox; Mark Effron; Thomas Stuckey; John J Griffin; Mark Turco; John D Carroll; Martin Fahy; Roxana Mehran; Gregg W Stone; |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: The American journal of cardiology Volume: 92 ISSN: 0002-9149 ISO Abbreviation: Am. J. Cardiol. Publication Date: 2003 Oct |
Date Detail:
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Created Date: 2003-09-30 Completed Date: 2003-10-28 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0207277 Medline TA: Am J Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 779-84 Citation Subset: AIM; IM |
Affiliation:
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Duke Clinical Research Institute, Durham, North Carolina 27715, USA. kandz002@mc.duke.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Angioplasty, Transluminal, Percutaneous Coronary / adverse effects, economics, statistics & numerical data* Antibodies, Monoclonal / therapeutic use* Anticoagulants / therapeutic use* Female Health Care Costs / statistics & numerical data Heparin / administration & dosage Humans Immunoglobulin Fab Fragments / therapeutic use* Length of Stay / statistics & numerical data Male Middle Aged Myocardial Infarction / drug therapy*, surgery* Outcome and Process Assessment (Health Care) Patient Discharge* Postoperative Care Stents Thrombosis / drug therapy, etiology |
| Chemical | |
Reg. No./Substance:
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0/Antibodies, Monoclonal; 0/Anticoagulants; 0/Immunoglobulin Fab Fragments; 143653-53-6/abciximab; 9005-49-6/Heparin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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