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Bagur, Rodrigo; Bertr, Olivier F; Rodes-Cabau, Josep; Larose, Eric; Rinfret, Stephane; Nguyen, Can M; Noel, Bernard; De Larochelliere, Robert; Poirier, Paul; Costerousse, Olivier; Roy, Louis;
Catheterization and Cardiovascular Interventions
Long Term Efficacy of Abciximab Bolus-Only Compared to Abciximab Bolus and Infusion After Transradial Coronary Stenting
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Background: No data are available on the long term efficacy of abciximab bolus-only with aspirin and clopidogrel pretreatment and systematic coronary stenting. Our objective was to evaluate the 3-year clinical outcomes in the EASY trial. Methods: After a bolus of abciximab (0.25 mg/kg) and uncomplicated transradial coronary stenting, 1,005 patients were randomized either to same-day home discharge and no infusion (bolus-only group, n=504) or to overnight hospitalization and 12 hours abciximab infusion (bolus + infusion group, n=501). In contrast, 343 patients were not randomized after stenting for safety reasons and received abciximab bolus and infusion (not-randomized group). The rate of major adverse cardiovascular events (MACE), including death, myocardial infarction (MI) and target vessel revascularization (TVR) after percutaneous coronary intervention (PCI) was evaluated. Results: Up to 3 years, the incidence of MACE remained similar in the two randomized groups, 14\% in bolus-only vs. 17\% in bolus + infusion (P=0.38). Similar efficacy was observed in subgroups analysis including higher-risk patients such as those with diabetes, unstable angina or non-ST elevation MI. Conversely, the incidence of MACE remained significantly higher in patients not-randomized post-PCI at all time intervals (P < 0.0001). The difference in outcomes between randomized and not-randomized patients was mostly accounted by the higher rates of MI, TVR as survival rate remained similar. Conclusion: In patients pretreated with aspirin and clopidogrel and undergoing uncomplicated coronary artery stenting, abciximab bolus-only was associated with similar outcomes compared with bolus followed by infusion, up to 3 years after PCI. Conversely, patients with suboptimal results or clinical complications during PCI remained at higher risk of late revascularization or MI. (C) 2009 Wiley-Liss, Inc.

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