Published Online
on December 3, 2008

A more recent version of this article appeared on February 1, 2009

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Original Article

Stent Parameters Predict Adverse Clinical Outcomes and Response to Platelet Glycoprotein IIb/IIIa Blockade: Findings of the ESPRIT Trial

James E. Tcheng^1,8; Ing Haan Lim²; Shankar Srinivasan³; Joseph Jozic⁴; C. Michael Gibson⁵; J. Conor O'Shea⁶; Joseph A. Puma⁷ and Daniel I. Simon⁴

¹ Duke Clinical Research Institute, Duke University Medical Center, Durham, NC;
² Tan Tock Seng Hospital, Singapore;
³ Schering-Plough Research Institute, Kenilworth, NJ;
⁴ University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH;
⁵ Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA;
⁶ Bon Secours Hospital, Cork, Ireland;
⁷ Lenox Hill Hospital, New York City, NY

http://cardiology.duke.edu

http://www.ttsh.com.sg

http://schering-plough.com

http://casemed.case.edu

http://www.uhhospitals.org

⁸ E-mail: tchen001{at}mc.duke.edu

Background—Only limited data describe relationships between stent parameters (length and diameter), adverse events following percutaneous coronary intervention (PCI), and effects of platelet glycoprotein IIb/IIIa blockade by stent parameters.

Methods and Results—In this post-hoc analysis of the 1,983 patients receiving a stent in the ESPRIT randomized PCI trial of eptifibatide versus placebo, rates of the major adverse cardiac event (MACE) endpoint (death, myocardial infarction, urgent target vessel revascularization or thrombotic bail-out) 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 18 to <30 mm (OR, 0.55 [95% CI, 0.32-0.94; P=0.030]) and 30 mm (OR, 0.43 [95% CI, 0.25-0.75; P=0.003]), stent diameters >2.5 to <3.5 mm (OR, 0.56 [95% CI, 0.39-0.82; P=0.002]), and with 2 stents implanted (OR, 0.39 [95% CI, 0.22-0.69; P=0.001]. 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 following PCI. Glycoprotein IIb/IIIa blockade mitigates much of the hazard of increasing procedural complexity.

Key Words: angioplasty • coronary disease • platelets • risk factors • stents

Related Article

Stent Parameters Predict Major Adverse Clinical Events and the Response to Platelet Glycoprotein IIb/IIIa Blockade: Findings of the ESPRIT Trial

James E. Tcheng, Ing Haan Lim, Shankar Srinivasan, Joseph Jozic, C. Michael Gibson, J. Conor O'Shea, Joseph A. Puma, and Daniel I. Simon
Circ Cardiovasc Interv 2009 2: 43-51. [Abstract] [Full Text] [PDF]