Abstract
Rotational atherectomy allows plaque remodeling in severely calcified lesions and, prior to the adoption of clopidogrel as standard therapy, small trials showed that abciximab reduces transient hypoperfusion associated with the procedure. However, no studies have evaluated it among patients receiving dual antiplatelet therapy. This study aimed to evaluate whether abciximab reduces procedure-related myocardial injury in a non-selected population of patients receiving dual antiplatelet therapy. The study comprised a retrospective review of a nonselected cohort of 139 consecutive procedures of rotational atherectomy performed in patients pre-treated with dual antiplatelet therapy. Abciximab was administered in 48 (34.5%) patients, whereas 91 (65.5%) did not receive it. The only difference between groups was a higher rate of diabetes mellitus in the abciximab group (89% vs. 51%, p=0.001). The rate of procedural complications was 10.5% for patients with abciximab vs. 6.2% for patients without (p=0.537). After 24 hours, the peak of biomarkers of myocardial damage (CKmb and TnT) did not differ, and the rate of procedure-related myocardial injury was 23.9% with abciximab and 20.7% without (p=0.664). In a restricted analysis to diabetic patients (n=84), the rate of myocardial injury was 27.5% with abciximab vs. 18.6% without, (p=0.435). After adjusting by clinical and procedural parameters in a logistic regression model, abciximab use did not confer any significant reduction on procedure-related myocardial injury. In conclusion, in a non-selected cohort of patients receiving dual antiplatelet therapy, the administration of abciximab in the setting of rotational atherectomy did not reduce the incidence of procedure related myocardial injury.
Highlights
Coronary calcium is commonly found, being present in 50% to 80% of individuals and increasing with age [1,2,3]
Among the 4832 procedures of percutaneous coronary interventions (PCI) performed in the 36 months study period, a total of 139 (2.9%) were rotational atherectomy (RA) and represent the study population
All of 139 patients were on dual antiplatelet therapy at the time of the RA
Summary
Coronary calcium is commonly found, being present in 50% to 80% of individuals and increasing with age [1,2,3]. In the setting of percutaneous coronary interventions (PCI), the presence of severely calcified lesions difficult the dilatation and may result in stent under expansion; severely calcified lesions are associated with a greater complication rate and worse long-term results [4,5,6] To deal with this limitation, rotational atherectomy (RA) allows plaque remodeling and facilitates stent implantation with a higher success and lower complication rates [7,8]. In this context, the use of abciximab during RA has been shown to reduce procedural morbidity as well as the incidence, extent and severity of transient hypoperfusion [9,10]. The role of abciximab in the current scenario of rotational atherectomy in patients receiving dual antiplatelet therapy has not been assessed
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