"rescue"-indikation für glykoprotein-IIb/IIIa-rezeptor-inhibition im rahmen perkutaner koronarintervention?

Translated title of the contribution: Effect of rescue abciximab administration during percutaneous coronary interventions

J. Herrmann, M. Haude, L. Volbracht, C. Altmann, C. Von Birgelen, H. Eggebrecht, N. Malyar, D. Baumgart, K. Mann, R. Erbel

Research output: Contribution to journalArticle

Abstract

Background: Previous clinical trials demonstrated the efficacy of glycoprotein IIb/IIIa receptor (GP IIb/IIIa) inhibition, started prior to a percutaneous coronary intervention, for the reduction of ischemic complications. The clinical efficacy of GP IIb/IIIa inhibition, started after the occurrence of procedural complications ("rescue" therapy), is less well determined. Objective: Incidence of ischemic myocardial injury during complicated coronary interventions with and without "rescue" therapy with the GP IIb/IIIa inbibitor abciximab. Methods: Matched-pair analysis of 66 consecutive patients with the application or omission of "rescue" abciximab therapy because of dissection (92.4%), side-branch occlusion (16.7%), distal embolization (6%), and no reflow (15.2%) during stent implantation. Detection of myocardial injury was made by ECG analysis, determination of serum activity of creatine kinase (CK, upper limit of normal (ULN) 70 IU/1 for women, 80 IU/1 for men), and point-of-care testing for cardiac troponin T (cTnT, threshold 0.1 ng/ml) before and 6, 12, and 24 hours after coronary intervention. Results: The incidence of a positive post-procedural cTnT status was higher in patients with "rescue" therapy than in patients without "rescue" therapy (66.7 versus 30.3%, p<0.01). Compared to the control group, the incidence of CK elevation (57.6% versus 33.3%, p=0.05) and Q-wave myocardial infarction (12.1 versus 3.0%, p=0.2) tended to be higher in the case group. No reflow was independently predictive of post-interventional CK elevation (p = 0.02), cTnT elevation (p = 0.03) and Q-wave myocardial infarction (0.01). Multiple stent implantation and "rescue" therapy were independently associated with post-procedural cTnT status (p = 0.01 and p<0.01, respectively). Conclusions: GP IIb/IIIa inhibition with abciximab, started in the cardiac catheterization laboratory as a rescue intervention after the occurrence of procedural complications other then acute thrombotic closure, does not seem to substantially reduce the incidence and extent of ischemic myocardial injury.

Translated title of the contributionEffect of rescue abciximab administration during percutaneous coronary interventions
Original languageGerman
Pages (from-to)520-528
Number of pages9
JournalIntensivmedizin und Notfallmedizin
Volume39
Issue number6
DOIs
StatePublished - Sep 1 2002

Keywords

  • Cardiac troponin T
  • Coronary intervention
  • Creatine kinase
  • Glycoprotein IIb/IIIa inhibition
  • Myocardial infarction
  • PCI

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Critical Care and Intensive Care Medicine

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    Herrmann, J., Haude, M., Volbracht, L., Altmann, C., Von Birgelen, C., Eggebrecht, H., Malyar, N., Baumgart, D., Mann, K., & Erbel, R. (2002). "rescue"-indikation für glykoprotein-IIb/IIIa-rezeptor-inhibition im rahmen perkutaner koronarintervention? Intensivmedizin und Notfallmedizin, 39(6), 520-528. https://doi.org/10.1007/s00390-002-0311-x