Influence of a platelet GPIIb/IIIa receptor antagonist on myocardial hypoperfusion during rotational atherectomy as assessed by myocardial Tc-99m sestamibi scintigraphy

Koch, Karl‐Christian; Dahl, Juergen vom; Kleinhans, E.; Klues, Heinrich G.; Radke, Peter W.; Ninnemann, Susanne; Schulz, G; Buell, Udalrich; Hanrath, Peter

doi:10.1016/s0735-1097(98)00659-7

Cited by 86 publications

(34 citation statements)

References 18 publications

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“…With the use of nuclear scintigraphy with sestamibi in patients undergoing coronary rotablation, intraprocedural perfusion defects have been duly noted, despite a lack of enzymatic evidence of myocardial necrosis ( Figure 6). 19 Besides direct imaging with echocardiography, magnetic resonance, and scintigraphy, there have been extensive new insights derived from markers of myocardial necrosis. Several years ago, the Coronary Angioplasty Versus Excisional Atherectomy (CAVEAT) investigators demonstrated for the first time in a large prospective trial that the incidence of periprocedural MI was much higher than generally accepted.…”

Section: New Window To Microvascular Obstructionmentioning

confidence: 99%

Recognition of the Importance of Embolization in Atherosclerotic Vascular Disease

2000

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Section: New Window To Microvascular Obstructionmentioning

confidence: 99%

Recognition of the Importance of Embolization in Atherosclerotic Vascular Disease

2000

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“…25 The activation of platelets appears to be promoted by fibrinolysis, due in part to the exposure of clot-bound thrombin. 26 By blocking platelet aggregation, abciximab may prevent the adverse effects of thrombolytic therapy on platelet function.…”

Section: The Effect Of Abciximab On Myocardial Reperfusionmentioning

confidence: 99%

Abciximab Improves Both Epicardial Flow and Myocardial Reperfusion in ST-Elevation Myocardial Infarction

et al. 2000

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MD; for the TIMI 14 InvestigatorsBackground-In the presence of ST-elevation myocardial infarction, patients with successful epicardial reperfusion (TIMI 3 flow) but persistent ST elevation on a 12-lead ECG are at high risk for subsequent death and left ventricular dysfunction. In the TIMI 14 trial, a dose-ranging angiographic study, combined therapy with abciximab plus reduced-dose tPA enhanced the speed and efficacy of epicardial reperfusion. We determined whether the combination of abciximab plus reduced-dose tPA provided additional benefit in terms of myocardial reperfusion, as evidenced by greater resolution of ST elevation. Methods and Results-All 346 patients with interpretable baseline and 90-minute ECGs, treated with either tPA alone or abciximab plus reduced-dose tPA (combination therapy), were included. Patients receiving combination therapy (nϭ221) had a 59% rate of complete (Ն70%) ST resolution at 90 minutes versus 37% in those treated with tPA alone (nϭ125) (PϽ0.0001). When the analysis was limited to patients with TIMI 3 flow, patients treated with combination therapy (nϭ151) remained significantly more likely to achieve complete ST resolution than those receiving tPA alone (nϭ80) (69% versus 44%; Pϭ0.0002). Conclusions-Combination

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“…Previous published studies showed that rotablation induces platelet activation, thus leading to platelet aggregation [18]. Small randomized trials found the benefit of abciximab during rotational atherectomy in reducing procedural morbidity, CK-MB elevation, as well as the incidence, extent and severity of transient hypoperfusion, as assessed by single-photon emission computed tomography [9,10].…”

Section: Discussionmentioning

confidence: 99%

“…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]. However, this evidence is supported by small trials performed prior to the adoption of clopidogrel as the standard therapy in patients undergoing PCI [11,12].…”

Section: Introductionmentioning

confidence: 99%

Lack of Peri-Procedural Myocardial Necrosis Reduction from Abciximab in Patients on Dual Antiplatelet Therapy Revascularized with Rotational Atherectomy

Pinar-Bermdez¹

2013

J Clin Exp Cardiolog

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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.

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Influence of a platelet GPIIb/IIIa receptor antagonist on myocardial hypoperfusion during rotational atherectomy as assessed by myocardial Tc-99m sestamibi scintigraphy

Abstract: These data indicate that GPIIb/IIIa blockade reduces incidence, extent and severity of transient hypoperfusion during PTRA. Thus, platelet aggregation may play an important role for PTRA-induced hypoperfusion.

Cited by 86 publications

References 18 publications

Recognition of the Importance of Embolization in Atherosclerotic Vascular Disease

Recognition of the Importance of Embolization in Atherosclerotic Vascular Disease

Abciximab Improves Both Epicardial Flow and Myocardial Reperfusion in ST-Elevation Myocardial Infarction

Lack of Peri-Procedural Myocardial Necrosis Reduction from Abciximab in Patients on Dual Antiplatelet Therapy Revascularized with Rotational Atherectomy

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