Blockage of platelet glycoprotein IIb/IIIa receptor by Reopro (c7E3 Fab- abciximab) has been shown to reduce markedly ischemic complications during and following elective and high-risk coronary intervention (CI). Between July '96 and February '98, 120 consecutive patients (85 men and 34 women, aged 34- 90 - mean 62) received Reopro (20 mg bolus, followed by 10 μg/min for 12-48 hours). 100 were treated with Reopro in the catheterization laboratory, in 76 as prophylactic treatment preceding high-risk CI and in 24 as bailout treatment for acute complications during CI. 20 additional patients were treated in the CCU for acute coronary syndromes, 17 of whom underwent CI 6- 48 hours later. Coronary angiography demonstrated multivessel disease in 66 (56%), and the target lesions were LAD - 77, RCA - 41, LCX - 22, SVG - 6, and 2 unprotected LMCA (total: 148 lesions dilated in 117 patient). Of the 117 CI, 44 were PTCA alone, and 73 included stenting. Indications for prophylactic Reopro for high risk CI were: acute MI (≤ 48 hours), early post-MI angina, unstable AP, and/or complex anatomy with visible thrombus. In this high-risk population the overall success rate (open artery, no MI, discharged alive, no need for urgent re-vascularization) was 97% when Reopro was given prophylactically prior to CI. The success rate was lower (87.5%) when Reopro was given in bailout situations. In 20 patients with acute coronary syndromes treated in the CCU while receiving maximal combined conventional therapy (including full-dose heparin), all symptoms and dynamic ischemic ECG changes disappeared within minutes following Reopro. 17 underwent successful CI during hospitalization and 3 were treated medically. Reopro given prior to high risk CI was associated with a very low rate of complications. In a few cases with acute coronary syndromes, Reopro given in the CCU cases immediate relief of myocardial ischemia and reduced the need for urgent coronary intervention.
|State||Published - 1 Jan 1999|
- Unstable angina