Platelet glycoprotein IIb/IIIa receptor inhibition as adjunctive treatment during saphenous vein graft stenting: differential effects after randomization to occlusion or filter-based embolic protection
| العنوان: | Platelet glycoprotein IIb/IIIa receptor inhibition as adjunctive treatment during saphenous vein graft stenting: differential effects after randomization to occlusion or filter-based embolic protection |
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| المؤلفون: | Roxana Mehran, Howard C. Herrmann, Gregg W. Stone, Richard E. Kuntz, Michael Jonas, David A. Cox, James B. Hermiller, Robert Feldman, Campbell Rogers, Jeffrey J. Popma |
| المصدر: | European Heart Journal. 27:920-928 |
| بيانات النشر: | Oxford University Press (OUP), 2006. |
| سنة النشر: | 2006 |
| مصطلحات موضوعية: | Male, medicine.medical_specialty, Randomization, medicine.medical_treatment, Urology, Coronary Disease, Platelet Glycoprotein GPIIb-IIIa Complex, Lower risk, Blood Vessel Prosthesis Implantation, Postoperative Complications, Blood vessel prosthesis, medicine, Humans, Saphenous Vein, Prospective Studies, Embolization, Aged, Bioprosthesis, business.industry, Stent, Balloon Occlusion, Embolic Protection Devices, Embolization, Therapeutic, Blood Vessel Prosthesis, Surgery, Treatment Outcome, Chemotherapy, Adjuvant, Adjunctive treatment, Female, Stents, Cardiology and Cardiovascular Medicine, business, Mace |
| الوصف: | Aims Although embolic protection devices reduce complications during saphenous vein graft (SVG) stenting, adverse events still occur in approximately 10% of patients. IIb/IIIa antagonists have not been proven effective during SVG intervention. We hypothesized that adjunctive use of these agents might enhance the efficacy of embolic protection devices. Methods and results In the prospective, multicentre FilterWire EX Randomized Evaluation trial, 651 patients undergoing SVG stenting were randomized to either filter-based FilterWire EX or balloon occlusion/aspiration GuardWire embolic protection devices. IIb/IIIa inhibitor use was at the discretion of the investigator, with randomization stratified by intended use. Patients pre-selected for IIb/IIIa inhibitor use (n = 345) had higher baseline risk, with increased 30-day major adverse cardiac events (MACE, 13.0 vs. 8.0%, P = 0.03). GuardWire assigned patients treated with IIb/IIIa inhibitors had higher 30-day MACE compared with those not treated with IIb/IIIa inhibitors (16.0 vs. 6.3%, P = 0.007). In contrast, MACE in high-risk FilterWire patients treated with IIb/IIIa inhibitors were similar to their lower risk, untreated counterparts (9.9 vs. 9.5%, P = 0.89). Multivariable analysis detected a borderline significant (P = 0.056) interaction for lower MACE between FilterWire and IIb/IIIa inhibitor use. Adjustment by the propensity to use IIb/IIIa inhibitors resulted in a significant (P = 0.023) interaction for lower MACE rates. IIb/IIIa inhibition in conjunction with FilterWire was associated with less abrupt closure, no reflow, or distal embolization. Conclusion IIb/IIIa antagonists may improve procedural outcome during SVG stenting in high risk patients, utilizing filter-based embolic protection devices. |
| تدمد: | 1522-9645 0195-668X |
| DOI: | 10.1093/eurheartj/ehi736 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::13e27eff6cbe9802d5401c664684b3ec https://doi.org/10.1093/eurheartj/ehi736 |
| Rights: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....13e27eff6cbe9802d5401c664684b3ec |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15229645 0195668X |
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| DOI: | 10.1093/eurheartj/ehi736 |