(Circulation. 1999;100:799-806.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Acute Platelet Inhibition With Abciximab Does Not Reduce In-Stent Restenosis (ERASER Study)
Correspondence to Stephen G. Ellis, MD, the Cleveland Clinic Foundation, 9500 Euclid Ave, F-25, Cleveland, OH 44195. E-mail elliss{at}cesmtp.ccf.org
Background—Although stents
reduce restenosis compared with balloon angioplasty, their
long-term efficacy is limited by neointimal hyperplasia.
Platelet and 
vß3 integrin receptor
inhibition limits neointimal proliferation in animal models
of arterial injury.
Methods and Results—We tested whether the dual ß3
integrin blocking agent abciximab, administered for 12 or 24 hours at
the same intravenous dose as that shown to reduce adverse
clinical events (death, infarction, and
revascularization) after angioplasty, would reduce
restenotic tissue volume, as measured by intravascular
ultrasound at 6 months. Two hundred twenty-five patients were randomly
allocated to placebo or abciximab before coronary intervention.
Of the 215 patients who received stents and study drug, 191 (88.8%)
returned for late (
4 months) coronary evaluation. Tissue
volume, expressed as a percentage of stent volume, did not differ:
25±15%, 27±15%, and 29±14% for the patients in the placebo and
the 12- and 24-hour abciximab groups, respectively. Lack of abciximab
benefit was confirmed by quantitative coronary angiography
(dichotomous restenosis: 11.6%, 18.9%, and 19.4%; loss
index: 0.33, 0.52, and 0.47, respectively, P=NS).
Conclusions—Potent platelet inhibition with abciximab, as administered in this study, does not reduce in-stent restenosis. The interrelationship between stents, platelets, and neointimal proliferation requires further study.
Key Words: angioplasty • stents • platelets • glycoproteins • vitronectin
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