July 4, 2000Circulation76 citationsOpen Access
Pronounced Benefit of Coronary Stenting and Adjunctive Platelet Glycoprotein IIb/IIIa Inhibition in Complex Atherosclerotic Lesions
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Key Result
Stenting with abciximab for complex coronary lesions reduced 1-year death or myocardial infarction compared to balloon angioplasty with placebo (8.0% vs 14.2%; HR 0.60, P=0.02).
Study Design
Type
RCT
Structured PICO
Does the combination of coronary stenting and abciximab reduce death, myocardial infarction, and target vessel revascularization in patients with complex atherosclerotic lesions?
P
Population
Patients with complex coronary lesions (long, tandem, severely calcified, restenotic, thrombotic, or ostial; total occlusions; bifurcations; saphenous vein grafts; and multivessel interventions) from the EPILOG and EPISTENT trials
I
Intervention
Stent with abciximab, balloon angioplasty with abciximab, or stent with placebo
C
Comparator
Balloon angioplasty with placebo
O
Outcome
Combined death or myocardial infarction at 1 yearcomposite
The combination of coronary stenting and abciximab provides additive long-term benefits in reducing death, myocardial infarction, and target vessel revascularization in patients with complex atherosclerotic lesions.
Main Result
Effect estimate: HR 0.60
Absolute Event Rate: 8% vs 14.2%
p-value: p=0.02
Abstract
BACKGROUND: Previous trials testing stents compared with balloon angioplasty excluded patients with complex lesions and did not assess the effect of adjunctive platelet IIb/IIIa inhibition. This analysis sought to assess the effect of stenting and abciximab specifically for patients with complex lesions. METHODS AND RESULTS: Patients with complex lesions (long, tandem, severely calcified, restenotic, thrombotic, or ostial; total occlusions; bifurcations; saphenous vein grafts; and multivessel interventions) from the Evaluation of PTCA to Improve Long-Term Outcome by c7E3 GP IIb/IIIa Receptor Blockade (EPILOG) and the Evaluation of Platelet IIb/IIIa Inhibitor for Stenting (EPISTENT) trials were included in the analysis. The 1-year combined death or myocardial infarction rates in the 4 treatment groups were as follows: balloon angioplasty/placebo, 14.2%; stent/placebo, 15.8%; balloon angioplasty/abciximab, 7.6%; and stent/abciximab, 8.0% (P<0.001). Death rates were 3.2%, 3.1%, 2.1%, and 0.5%, respectively (P=0.03). The incidence of target vessel revascularization at 1 year was 30.5%, 18.0%, 24.4%, and 19.7% in the 4 groups, respectively (P<0.001). After adjustment for baseline differences, multivariate analysis demonstrated that the rate of death or myocardial infarction was independently reduced by balloon angioplasty/abciximab (hazard ratio, 0.51; P<0.001) and stent/abciximab (hazard ratio, 0.60; P=0.02) but was not affected by the use of stents alone. Conversely, target vessel revascularization was reduced by stent/placebo (hazard ratio, 0.53; P<0.001), stent/abciximab (hazard ratio, 0.58; P<0.001), and balloon angioplasty/abciximab (hazard ratio, 0.74; P=0.006) compared with balloon angioplasty/placebo, respectively. CONCLUSIONS: The combination of stenting and abciximab during percutaneous coronary interventions for patients with angiographically complex lesions confers additive long-term benefit with respect to death, myocardial infarction, and target vessel revascularization.