January 16, 2006European Heart Journal
Platelet glycoprotein IIb/IIIa receptor inhibition as adjunctive treatment during saphenous vein graft stenting: differential effects after randomization to occlusion or filter-based embolic protection
Key result
IIb/IIIa inhibitors during SVG stenting increase MACE with GuardWire while showing no benefit with FilterWire.
- P=0.03
- n=651
Why the study?
Although embolic protection devices reduce complications during saphenous vein graft stenting, adverse events still occur in approximately 10% of patients and the efficacy of IIb/IIIa antagonists during SVG intervention is unproven.
Does adjunctive glycoprotein IIb/IIIa receptor inhibition improve 30-day MACE in patients undergoing saphenous vein graft stenting with embolic protection devices?
Population
651 patients undergoing saphenous vein graft stenting
Comparison
IIb/IIIa inhibitor use vs no IIb/IIIa inhibitor use with FilterWire EX or GuardWire embolic protection devices
Design
Prospective multicentre randomized trial stratified by intended IIb/IIIa inhibitor use
Follow-up
30 days
Authors
Discussion
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Member takes
Implication
Device-specific effects caution against routine IIb/IIIa use with GuardWire in SVG stenting; extends evidence for tailored embolic protection strategies.
Study Design
Type
RCT (n=651)
Randomization
Stratified by intended use of IIb/IIIa inhibitors
Multicenter
Yes
Structured PICO
Does adjunctive glycoprotein IIb/IIIa receptor inhibition improve 30-day MACE in patients undergoing saphenous vein graft stenting with embolic protection devices?
P
Population
651 patients undergoing saphenous vein graft stenting randomized to filter-based or balloon occlusion embolic protection, evaluated for 30-day outcomes based on IIb/IIIa inhibitor use.
I
Intervention
Glycoprotein IIb/IIIa receptor inhibitors used adjunctively with filter-based embolic protection (FilterWire EX) or balloon occlusion/aspiration (GuardWire)
C
Comparator
No glycoprotein IIb/IIIa receptor inhibitors
O
Outcome
30-day major adverse cardiac events (MACE)composite
Main Result
Absolute Event Rate: 13% vs 8%
p-value: p=0.03
Adjunctive use of glycoprotein IIb/IIIa inhibitors may improve procedural outcomes and reduce 30-day MACE during saphenous vein graft stenting when used specifically with filter-based embolic protection devices.
Cite This Study
Jonas et al. (2006) conducted an RCT in Saphenous vein graft (SVG) stenting (n=651). IIb/IIIa inhibitors (in conjunction with FilterWire EX or GuardWire) vs. No IIb/IIIa inhibitors was evaluated on 30-day major adverse cardiac events (MACE) (p=0.03). Adjunctive IIb/IIIa inhibitor use during SVG stenting had a significant interaction with device type, yielding similar 30-day MACE with FilterWire (9.9% vs 9.5%) but higher MACE with GuardWire.