Eugene McFadden from Rotterdam in the Netherlands looked at the coronary use of platelet GPIIb/IIIa inhibitors and the results from the cardiology trials. He discussed the EPIC trial which looked at ReoPro (abciximab) use in high-risk patients, EPILOG for all-comer balloon angioplasty and EPISTENT which also factored in stenting as patients were divided into three groups (stent plus placebo, stent plus abciximab and PTCA plus abciximab). This showed a striking 1% reduction in mortality if abciximab was used and this benefit was maintained at three years.
One of the key findings with the use of ReoPro was the benefit seen in patients with diabetes. Diabetics have a 50% greater chance of dying in the first year after intervention but with ReoPro treatment the risk was reduced to that of a non-diabetic patient. For facilitated PCI the combination of reduced-dose thrombolysis and standard dose ReoPro results in a 94.4% versus an 84% freedom from death based on the SPEED trial.
McFadden concluded that abciximab has shown a consistent survival benefit in 10 trials and 12,000 PCI patients. On meta-analysis, there was a significant reduction in mortality which approximated 20% and which persists at 3-7 years follow-up, with little excess risk of serious bleeding. Accordingly, approximately 65% of all coronary interventions in the US and UK use GPIIb/IIIa inhibitors.
In discussion afterwards McFadden was asked about the mode of action to reduce mortality risk, and he pointed to both focal lesion and microcirculatory effects preventing embolization as possibly important contributory factors.
Gunnar Tepe from Tuebingen in Germany then talked about the limitations of thrombolysis in acute peripheral arterial occlusions which included limited success, long lysis time and high rates of re-occlusion. The PROMPT trial of 70 patients, he explained, with a prospective placebo controlled, 5-2 randomisation showed the relative safety of using abciximab in acute peripheral occlusions. Next he looked at the results of the RELAX trial (PI: Ken Ouriel) concluding that the RELAX trial comparing lytic monotherapy with lytic in combination with abciximab suggested a trend towards improved efficacy of thrombolysis and a reduction in distal embolization requiring intervention in the latter reteplase/abciximab combination dosing arms.
Iris Baumgartner next looked at the promising early results for non-coronary use of abciximab in the RIO trial; a prospective, randomised, double-blind, placebo-controlled trial including patients with femoral-popliteal occlusions of >5cm in length with a history of more than six weeks. Baumgartner concluded that adjunctive abciximab treatment reduces early reocclusions and mid-term restenoses in peripheral “high-risk” interventions, giving a better clinical outcome at six months follow-up as compared to placebo, but is associated with a slightly increased local complication rate. She affirmed the need for more assessment of these approaches alongside cost-effectiveness evaluation.
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