Evidence for Prevention of Death and Myocardial Infarction With Platelet Membrane Glycoprotein IIb/III Receptor Blockade by Abciximab (c7E3 Fab) Among Patients With Unstable Angin Undergoing Percutaneous Coronary Revascularization

Objectives. We sought to evaluate whether patients with unstable angin undergoing coronary intervention derive particular clinical benefit from potent platelet inhibition. Background. Plaque rupture and platelet aggregation are pathogenetic processes common to unstable angin and ischemic complications of percutaneous coronary intervention. Methods. Of the 2,099 patients undergoing coronary intervention in the Evaluation of 7E3 in Preventing Ischemic Complications (EPIC) trial, 489 were enrolled with the diagnosis of unstable angin and randomized to receive placebo, an abciximab (c7E3) bolus immediately before the intervention or an abciximab bolus followed by 12-h infusion. The primary end point was composite of death, myocardial infarction (MI) or urgent repeat revascularization within 30 days of randomization. The occurrence of death, MI or any revascularization within 6 months was also assessed. Results. Compared with placebo, the bolus and infusion of abciximab resulted in 62% reduction in the rate of the primary end point (12.8% vs. 4.8%, p = 0.012) among patients with unstable angina, due primarily to reduction in the incidences of death (3.2% vs. 1.2%, p = 0.164) and MI (9% vs. 1.8%, p = 0.004). By 6 months, cumulative death and MI were further reduced by abciximab (6.6% vs. 1.8%, p = 0.018 and 11.1% vs. 2.4%, p = 0.002, respectively). The magnitude of the risk reduction with abciximab was greater among the patients with unstable angin than among other patients in the EPIC trial without unstable angin for the end points of death (interaction: p = 0.008 at 30 days, p = 0.002 at 6 months) and MI (interaction: p = 0.004 at 30 days, p = 0.003 at 6 months). Conclusions. The syndrome of unstable angin identifies patients who will experience particularly marked reductions in the risk of death and MI with abciximab during coronary intervention.