Published online before print December 3, 2008, doi: 10.1161/CIRCINTERVENTIONS.108.809285
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Original Articles |
Stent Parameters Predict Major Adverse Clinical Events and the Response to Platelet Glycoprotein IIb/IIIa Blockade
Findings of the ESPRIT Trial
From the Duke Clinical Research Institute (J.E.T.), Duke University Medical Center, Durham, NC; Tan Tock Seng Hospital (I.H.L.), Singapore, Singapore; Schering-Plough Research Institute (S.S.), Kenilworth, NJ; University Hospitals Case Medical Center (J.J.), Case Western Reserve University School of Medicine, Cleveland, Ohio; Beth Israel Deaconess Medical Center (C.M.G.), Harvard Medical School, Boston, Mass; Bon Secours Hospital (J.C.O.), Cork, Ireland; Lenox Hill Hospital (J.A.P.), New York City, NY; and University Hospitals Case Medical Center (D.I.S.), Case Western Reserve University School of Medicine, Cleveland, Ohio.
Correspondence to James E. Tcheng, MD, Duke Clinical Research Institute, Suite 403, 2424 Erwin Road, Durham, NC 27705. E-mail tchen001{at}mc.duke.edu
Received July 28, 2008; accepted December 1, 2008.
Background— Only limited data describe relationships between stent parameters (length and diameter), adverse events after percutaneous coronary intervention, and effects of platelet glycoprotein IIb/IIIa blockade by stent parameters.
Methods and Results— In this post hoc analysis of the 1983 patients receiving a stent in the Enhanced Suppression of the Platelet Glycoprotein IIb/IIIa Receptor with Integrilin Therapy randomized percutaneous coronary intervention trial of eptifibatide versus placebo, rates of the major adverse cardiac event (MACE) end point (death, myocardial infarction, urgent target-vessel revascularization, or thrombotic bailout) at 48 hours and 1 year were correlated with stent parameters and then analyzed by randomization to eptifibatide versus placebo. In the placebo group, MACE increased with number of stents implanted, total stent length (by quartiles of <15, 15 to <18, 18 to <30, and 
30 mm), and total stented vessel area (by quartiles of area <141, 141 to <188, 188 to <292, and 292 mm2). By stent parameters, MACE at 48 hours was reduced in the eptifibatide group at stent lengths of 18 to <30 mm (odds ratio [OR], 0.55; 95% CI, 0.32 to 0.94; P=0.030) and 30 mm (OR, 0.43; 95% CI, 0.25 to 0.75; P=0.003), stent diameters of >2.5 to <3.5 mm (OR, 0.56; 95% CI, 0.39 to 0.82; P=0.002), and with 2 stents implanted (OR, 0.39; 95% CI, 0.22 to 0.69; P=0.001). In the placebo group, near-linear relationships were observed between both increasing stent length and increasing stented vessel area and MACE at 48 hours and 1 year (all, P<0.001); these gradients were flattened in the eptifibatide group (P=0.005 for stent length).
Conclusions— Stent parameters predict MACE after percutaneous coronary intervention. Glycoprotein IIb/IIIa blockade mitigates much of the hazard of increasing procedural complexity.
Key Words: angioplasty • coronary disease • platelets • risk factors • stents
CLINICAL PERSPECTIVE
Guest Editor for this article was Antonio Colombo, MD.
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