Thrombus predicts ischemic complications during percutaneous coronary intervention in saphenous vein grafts: Results from TARGET (do tirofiban and reopro give similar efficacy trial?)

Autor: Howard C. Herrmann, James C. Blankenship, David J. Moliterno, Arun Kalyanasundaram, Peter B. Berger, Rick R. McClure
Rok vydání: 2007
Předmět:
Male
Reoperation
medicine.medical_specialty
Abciximab
medicine.medical_treatment
Myocardial Infarction
Coronary Disease
Platelet Glycoprotein GPIIb-IIIa Complex
Coronary Angiography
Immunoglobulin Fab Fragments
Double-Blind Method
Predictive Value of Tests
Risk Factors
Internal medicine
medicine
Humans
Saphenous Vein
Radiology
Nuclear Medicine and imaging
cardiovascular diseases
Myocardial infarction
Angioplasty
Balloon
Coronary
Thrombus
Aged
Venous Thrombosis
Analysis of Variance
business.industry
Graft Occlusion
Vascular
Antibodies
Monoclonal
Percutaneous coronary intervention
General Medicine
Tirofiban
Middle Aged
medicine.disease
Survival Analysis
Surgery
Treatment Outcome
Research Design
Glycoprotein IIb/IIIa inhibitors
Conventional PCI
Cardiology
Tyrosine
Female
Cardiology and Cardiovascular Medicine
business
Platelet Aggregation Inhibitors
Mace
medicine.drug
Zdroj: Catheterization and Cardiovascular Interventions. 69:623-629
ISSN: 1522-726X
1522-1946
DOI: 10.1002/ccd.20963
Popis: Background: Saphenous vein graft (SVG) percutaneous coronary intervention (PCI) carries a high risk of ischemic complications. However, there are scant recent data to identify which SVG lesions carry particularly high risk in recent years. We studied demographic and angiographic factors associated with ischemic complications after SVG PCI without distal protection in the TARGET (do tirofiban and reopro give similar efficacy trial?) study. Methods: TARGET was a multicenter double-dummy, double-blinded study randomizing 4,809 PCI patients to tirofiban or abciximab. Of these, 254 patients underwent PCI involving an SVG lesion. The primary endpoint of this analysis was major adverse cardiac events (MACEs) at 30 days, including death, nonfatal myocardial infarction (MI), and urgent target vessel revascularization. Results: No demographic characteristic was associated with 30-day MACE. Lesion length > 20 mm (odds ratio [OR] = 2.7, P = 0.03), thrombus (OR = 3.9, P = 0.003), eccentricity (P = 0.001), thrombolysis in myocardial infarction flow 1 target lesion (OR = 2.5, P = 0.035) were univariate variables associated with 30-day MACE. Multivariate analysis associated only thrombus (OR = 3.8, P = 0.015) with 30-day MACE. No difference in outcomes was noted between patients receiving abciximab and tirofiban. SVG patients had lesser angiographic success (95.6% vs. 98%, P = 0.04) and increased 30-day Q-wave MI (2.5% vs. 0.9%, P = 0.039) compared with non-SVG patients, but a similar incidence of death (0% vs. 0.4%), non-Q-MI (5.9% vs. 4.5%), and target vessel revascularization (0.5% vs. 1%). Conclusion: In the era of routine stenting and GpIIb/IIIa inhibitors, thrombus is the angiographic characteristic most closely associated with adverse outcomes of SVG PCI © 2006 Wiley-Liss, Inc.
Databáze: OpenAIRE
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