Journal Article

Abciximab-facilitated percutaneous coronary intervention and long-term survival—a prospective single-center registry

Sorin J. Brener, Stephen G. Ellis, Jakob Schneider, Carolyn Apperson-Hansen and Eric J. Topol

in European Heart Journal

Published on behalf of European Society of Cardiology

Volume 24, issue 7, pages 630-638
Published in print April 2003 | ISSN: 0195-668x
Published online April 2003 | e-ISSN: 1522-9645 | DOI: https://dx.doi.org/10.1016/S0195-668X(02)00812-6
Abciximab-facilitated percutaneous coronary intervention and long-term survival—a prospective single-center registry

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Aims To identify predictors of use of abciximab and evaluate the long-term survival after percutaneous coronary intervention with or without abciximab in a broad spectrum of patients.

Methods We prospectively evaluated, in a dedicated registry, the 4-year survival of patients undergoing percutaneous revascularization and the treatment with or without abciximab, using the Social Security Death Index.

Results Among 10,471 patients treated between 2/1/1995 and 12/31/2001, 5655 received abciximab and 4816 did not. Propensity score analysis (c-statistic 0.83) identified the following variables to be independently associated with abciximab use: later date of procedure, stent use, acute or recent infarction, increasing lesion complexity, vein graft intervention, hyperlipidemia, normal renal function, male gender and decreasing age. Procedural success was higher in the abciximab group, 93 vs. 89%, [math]. Unadjusted Kaplan–Meyer survival analysis demonstrated a strong trend for improved survival in the abciximab group at 4 years, 86.3 vs. 84.7%, [math]. In the 7533 patients with acute coronary syndromes (ACS), the respective values were 86.0 vs. 83.6%, [math]. Multivariate Cox proportional hazard analysis identified increasing age, significant left ventricular dysfunction or congestive heart failure, chronic renal insufficiency and diabetes mellitus as main predictors of mortality. Abciximab was independently associated with improved survival only in patients with ACS (adjusted HR 0.87, 95% confidence interval, 0.81–1.00, [math]). Abciximab use was associated with a higher rate of access site hematoma (2.8 vs. 1.5%) and blood product transfusion (6.8% vs. 4.8%), [math] for both.

Conclusion Abciximab use improves procedural success and is associated with lower 4-year mortality in patients with ACS, for whom it should be strongly considered. A lesser effect is seen in patients without high-risk characteristics.

Keywords: CABG=Coronary artery bypass grafting; CCF=Cleveland Clinic Foundation; CI=Confidence interval; EPIC=Evaluation of c7E3 for the prevention of ischemic complications; EPILOG=Evaluation of PTCA to improve long-term outcome by c7E3 glycoprotein receptor blockade; EPISTENT=Evaluation of platelet IIb/IIIa inhibitor for stenting; GP IIb/IIIa=Platelet glycoprotein IIb/IIIa receptor; HR=Hazard ratio; MI=Myocardial infarction; PCI=Percutaneous coronary intervention; RCT=Randomized clinical trial; TIMI flow grade=Thrombolysis in myocardial infarction flow grade; Abciximab; Percutaneous coronary intervention; Survival

Journal Article.  3419 words.  Illustrated.

Subjects: Cardiovascular Medicine

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