Assuntos
Angioplastia Coronária com Balão , Anticorpos Monoclonais/uso terapêutico , Angiografia Coronária , Fragmentos Fab das Imunoglobulinas/uso terapêutico , Peptídeos/uso terapêutico , Complexo Glicoproteico GPIIb-IIIa de Plaquetas/antagonistas & inibidores , Tirosina/análogos & derivados , Tirosina/uso terapêutico , Abciximab , Angioplastia Coronária com Balão/efeitos adversos , Anticorpos Monoclonais/efeitos adversos , Creatina Quinase/sangue , Creatina Quinase Forma MB , Eptifibatida , Humanos , Fragmentos Fab das Imunoglobulinas/efeitos adversos , Isoenzimas/sangue , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/etiologia , Peptídeos/efeitos adversos , Estudos Prospectivos , Fatores de Risco , Tirofibana , Tirosina/efeitos adversosRESUMO
BACKGROUND: Abciximab has been shown to reduce ischemic complications and creatine kinase-myocardial band (CK-MB) elevation of both simple and complex coronary interventions. In addition to the procedural complications, one of the important mechanisms for CK-MB elevation after rotational atherectomy is an interaction between platelets and the atheromatous debris. METHODS: This study was conducted to determine whether abciximab would limit the extent of periprocedural CK-MB release after rotational atherectomy of American Heart Association/American College of Cardiology type B(2) lesions in a double-blind, randomized, placebo-controlled manner. A total of 100 lesions in 100 patients were randomized with the primary end point being a CK-MB elevation of >16 U/L. RESULTS: Procedural success was achieved in 100% in the abciximab arm compared with 98% in the placebo group with any CK-MB elevation >16 U/L of 8% in the abciximab versus 22% in the placebo group (P =.04). The peak creatine phosphokinase level (units per liter) was 102 +/- 14 versus 153 +/- 22 (P =.05) and the peak CK-MB level was 12.8 +/- 1.8 versus 24.6 +/- 3.5 (P =.06) between the abciximab and placebo groups, respectively. Slow-flow or postprocedure chest pain occurred in 14% in the abciximab group versus 30% in the placebo group (P =.04). There was 1 Q-wave myocardial infarction in the placebo arm and 1 nonhemorrhagic stroke in the abciximab group. CONCLUSIONS: Therefore the Rota ReoPro randomized trial revealed the benefit of abciximab during rotational atherectomy in reducing procedural morbidity and CK-MB elevation, and its routine use can be justified even in moderately complex lesions undergoing rotational atherectomy.