European Heart Journal Advance Access originally published online on January 16, 2006
European Heart Journal 2006 27(8):920-928; doi:10.1093/eurheartj/ehi736
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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
1Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA
2New York Presbyterian Hospital/Cardiovascular Research Foundation, New York, NY, USA
3St Vincent Hospital, Indianapolis, IN, USA
4Evanston Hospital, Evanston, IL, USA
5Hospital of the University of Pennsylvania, Philadelphia, PA, USA
6Mid Carolina Cardiology, Charlotte, NC, USA
Received 7 March 2005; revised 23 November 2005; accepted 22 December 2005; online publish-ahead-of-print 16 January 2006.
* Corresponding author. E-mail address: crogers{at}partners.org
See page 891 for the editorial comment on this article (doi:10.1093/eurheartj/ehi797)
Aims Although embolic protection devices reduce complications during saphenous vein graft (SVG) stenting, adverse events still occur in 
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.
Key Words: Saphenous vein graft • Stent • Glycoprotein IIb/IIIa antagonists • Embolic protection devices
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EHJ 2006 27: 891-892.[Extract] [Full Text]
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