Published online before print November 18, 2002, doi: 10.1161/01.CIR.0000041250.89627.A9
(Circulation. 2002;106:3063.)
© 2002 American Heart Association, Inc.
Clinical Investigation and Reports |
Lack of Benefit From Intravenous Platelet Glycoprotein IIb/IIIa Receptor Inhibition as Adjunctive Treatment for Percutaneous Interventions of Aortocoronary Bypass Grafts
A Pooled Analysis of Five Randomized Clinical Trials
From the Division of Cardiology (M.R.), University Hospital, Zurich, Switzerland; Department of Cardiovascular Medicine (D.L.B., L.C., K.M.Z., D.M.B., S.G.E., E.J.T.), The Cleveland Clinic Foundation, Cleveland, Ohio; University of Michigan (D.M.), Ann Arbor, Mich; Harvard School of Public Health (D.P.C.), Boston, Mass; and St Thomas Hospital (M.A.R.), Nashville, Tenn.
Correspondence to Eric J. Topol, MD, Department of Cardiovascular Medicine, Desk F25, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195. E-mail topole{at}ccf.org
Background— Despite widespread use of platelet glycoprotein (GP) IIb/IIIa receptor inhibitors for percutaneous coronary interventions (PCI) of bypass grafts, data supporting this strategy are lacking.
Methods and Results— A pooled analysis of 5 randomized intravenous GP IIb/IIIa inhibitor trials (EPIC, EPILOG, EPISTENT, IMPACT II, and PURSUIT) was performed, and outcomes of graft interventions were assessed at 30 days and 6 months. Compared with PCI of native circulation (n=13 158), graft interventions (n=627) were associated with worse outcomes and in particular with a doubling of mortality at 30 days (2.1% versus 1.0%, P=0.006) and 6 months (4.7% versus 2.0%, P<0.001). Revascularization of a graft was identified as an independent predictor of death, myocardial infarction, or revascularization at 6 months (hazard ratio, 1.42; 95% CI, 1.24 to 1.63; P<0.001). Among patients undergoing graft PCI, the incidence of the triple end point at 30 days was 16.5% in the platelet GP IIb/IIIa inhibitor group and 12.6% in the placebo group (odds ratio, 1.38; 95% CI, 0.85 to 2.24; P=0.18). At 6 months, 39.4% of patients randomized to GP IIb/IIIa inhibitors and 32.7% of patients allocated to placebo had an ischemic event (hazard ratio, 1.29; 95% CI, 0.97 to 1.72; P=0.07).
Conclusions— Intravenous platelet GP IIb/IIIa receptor inhibition does not improve outcomes after PCI of bypass grafts. In the absence of mechanical emboli protection, this procedure is associated with high incidence of death and nonfatal ischemic events.
Key Words: angioplasty • bypass • platelets • glycoproteins • stents
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