Impact of Platelet Glycoprotein IIb/IIIa Inhibitor Therapy on In-Hospital Outcomes and Long-Term Survival Following Percutaneous Coronary Rotational Atherectomy |
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Authors: | Jeffrey?S.?Berger,James?N.?Slater,Warren?Sherman,Stephen?J.?Green,Timothy?A.?Sanborn,David?L.?Brown author-information" > author-information__contact u-icon-before" > mailto:david.brown@stonybrook.edu" title=" david.brown@stonybrook.edu" itemprop=" email" data-track=" click" data-track-action=" Email author" data-track-label=" " >Email author |
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Affiliation: | (1) Beth Israel Medical Center, New York, NY;(2) New York University School of Medicine, New York, NY;(3) Mt. Sinai School of Medicine, New York, NY;(4) North Shore University Hospital, Manhasset, New York;(5) Evanston Hospital, Evanston, Ill;(6) Stony Brook University School of Medicine, Stony Brook, NY;(7) Division of Cardiovascular Medicine, Stony Brook University School of Medicine, Health Sciences Center T16-080, Stony Brook, NY, 11754, USA |
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Abstract: | Background: Percutaneous coronary rotational atherectomy (PCRA) is a potent stimulus of platelet activation and aggregation in vivo. For this reason, many patients undergoing PCRA are treated with platelet glycoprotein (GP) IIb/IIIa inhibitors. However, there is limited data regarding the ability of GP IIb/IIIa inhibitors to reduce ischemic complications of PCRA and no data regarding their effect on long-term survival.Methods: Data on 1138 consecutive patients undergoing PCRA in 5 hospitals in 1998–1999 were pooled and analyzed. Long-term survival was available for all 530 patients treated in 3 of the hospitals.Results and conclusions: GP IIb/IIIa inhibitors were administered to 315 of 1138 (28%) PCRA patients. There was no difference in age, gender or race among patients treated with and without GP IIb/IIIa antagonists. The prevalence of hypertension, diabetes, renal insufficiency and peripheral vascular disease did not differ between groups. Unstable angina was more common among patients treated with GP IIb/IIIa inhibitors (45% vs. 38%, P = 0.036)Patients treated with GP IIb/IIIa inhibitors had lower ejection fractions (50% vs. 55%, P < 0.001) and more 3-vessel coronary disease (24% vs. 16%, P = 0.002). Angiographic success was over 99% in both groups (P = NS). The frequency of major adverse cardiovascular events (MACE) was slightly greater in GP IIb/IIIa inhibitor treated patients (3.8% vs. 2.2%, P = 0.126). At a mean follow-up of 3 years, mortality was 13.3% in the GP IIb/IIIa treated patients and 12% in the untreated patients (P = 0.224). On Cox proportional hazards analysis, treatment with a GP IIb/IIIa inhibitor was not significantly associated with increased survival (Hazard Ratio, 0.81, 95% Confidence Interval, 0.631–1.039, P = 0.098). These data do not indicate a significant association between GP IIb/IIIa inhibitor treatment during PCRA and MACE or survival.Condensed Abstract. There is limited data regarding the ability of GP IIb/IIIa inhibitors to reduce ischemic complications of percutaneous coronary rotational atherectomy (PCRA) and no data regarding their effect on long-term survival. These data do not indicate a significant association between GP IIb/IIIa inhibitor treatment during PCRA and MACE or survival. |
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Keywords: | platelet aggregation inhibitors atherectomy |
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