Abciximab Usage in Percutaneous Coronary Intervention in High-Risk Patients: Early and Late Outcomes

Abstract

Background: Clinical adverse cardiac events have been significantly reduced by the adjunctive usage of Glycoprotein IIb/IIIa receptor inhibitors in patients undergoing percutaneous coronary intervention (PCI). However, no information on its safety and efficacy is available for Asian. Methods: All patients who had PCI together with abciximab in the Prince of Wales Hospital from August 1998 to December 2000 were included. Hospital records, ECG records and laboratory results were reviewed retrospectively. The primary composite endpoint including death, myocardial infarction, target vessel revascularization or bypass surgery was assessed at index hospitalization, at 1 month, and 6 months after PCI. The safety of abciximab and any difference in outcomes between the prophylactic and standby group were studied. Results: One hundreds and five patients had PCI together with abciximab during the study period. All received bolus abciximab of 0.25 mg/kg followed by 0.125 µg/kg/min infusion over 12 hours. Twenty-one patients had experienced the primary endpoint at the index hospitalization (7 from the prophylactic group and 14 from the standby group). Additional 3 patients in the prophylactic group had reached primary endpoint at 1 month. At 6 months, another 1 in the prophylactic group and 4 in the standby group reached primary endpoint. Total 5 deaths occurred during the index hospitalization, 2 from prophylactic group and 3 from standby group. The bleeding complication was similar in both groups and most of them were minor bleeding only. Three patients had severe thrombocytopenia (platelet count less than 20x109 /l) and total 6 patients had thrombocytopenia of <50x109/l. Conclusion: There was a trend towards better clinical outcome in the abciximab prophylactic group and the benefit seemed to be sustained at 6 months. Low incidence of major bleeding was observed in the usage of abciximab, but the incidence of thrombocytopenia after abciximab usage in Chinese was much higher than reported in current published studies.