Abstract

Background The CAPTURE study (c 7E3 A nti P lateletT herapy in U nstable Re fractory angina) was designed to assess outcome in patients with refractory angina undergoing angioplasty, receiving either abciximab or placebo.

Methods One thousand two hundred and sixty-five patients with refractory unstable angina, defined as recurrent myocardial ischaemia despite medical treatment including heparin and nitrates were enrolled. After angiography, patients received an infusion of abciximab or placebo over 18–24h preceding angioplasty, continuing until 1h after the procedure. In 1197 patients undergoing angioplasty the angiographic committee centrally reviewed the baseline as well as the procedural angiograms. Coronary flow and lesion characteristics were assessed in the baseline angiogram as well as before intervention. Angiographic outcome, reason for failure as well as complications were assessed after angioplasty.

Results At 30 days follow-up, patients receiving abciximab (n=595) compared with placebo (n=602) had a 30% reduction in the composite primary end-point death, myocardial infarction or urgent (re)intervention: 10·8% vs 15·4% (P=0·017). Baseline demographics were identical in the angiogram available group compared with the total study group. At 30 days, the non-angiogram available patients showed a higher incidence of events compared to those in whom the angiogram was reviewed: 19·4 vs 13·1% (P=ns). Lesion characteristics and coronary flow were not different at baseline between the placebo and abciximab groups. A primary end-point was reached in 9·6% of both placebo and abciximab patients with type A or B1lesions, in 17·0% vs 12·0% with type B2lesions, and in 19·1% vs 11·5% with type >B2or C lesions. Sixty-one percent of placebo and abciximab patients had TIMI 3 flow at baseline angiography. Pre-angioplasty TIMI 3 flow was observed in 69% and 72% respectively. The thrombus was resolved between the angiograms in 22% and 43% respectively, in the placebo and abciximab groups (P=0·033). Angiographic success of the procedure was achieved in 88% and 94% in the placebo and abciximab patients, respectively (P<0·001). Stents were implanted in the ischaemia-related artery in 56 and 60 patients, respectively. However, failure of the stent procedure was more frequent in the placebo group than in the abciximab group, nine vs no patients (P=0·003).

Conclusion More frequent thrombus resolution was observed and a higher angiographic success rate was achieved in patients treated with abciximab before and during angioplasty compared with placebo. Patients with complex lesions as the underlying pathology reached fewer end-points if treated with abciximab before and during angioplasty.

f1
Correspondence: Dr M. van den Brand, Thoraxcenter BD 412, University Hospital Dijkzigt Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.

References

1
Theroux
P
, Quimet H, McCans J. Aspirin, heparin, or both to treat acute unstable angina.
N Engl J Med
 .
1988
;
319
:
1105
–1111
2
van Miltenburg-van Zijl
A
, Simoons ML, Veerhoek RJ, Bossuyt PM. Incidence and follow-up of Braunwald subgroups in unstable angina pectoris.
J Am Coll Cardiol
 .
1995
;
25
:
1286
–1292
3
Goldman
BS
, Katz A, Christakis G, Weisel R. Determinants of risk for coronary artery bypass grafting in stable and unstable angina pectoris.
Can J Surg
 .
1985
;
28
:
505
–508
4
de Feyter
PJ
, Suryapranata H, Serruys PW. Coronary angioplasty for unstable angina: immediate and late results in 200 consecutive patients with identification of risk factors for unfavorable early and late outcome.
J Am Coll Cardiol
 .
1988
;
12
:
324
–333
5
van den Brand
MJBM
, Simoons ML, de Boer MJ, van Miltenburg A, van der Wieken LR, de Feyter PJ. Antiplatelet therapy in therapy—resistant unstable angina. A pilot study with REO-PRO (c7E3).
Eur Heart J
 .
1995
;
16
:
36
–42
6
N Engl J Med
 .
1994
;
330
:
956
–961
7
Lancet
 .
1997
;
349
:
1429
–1435
8
Ryan
TJ
, Faxon DP, Gunnar RM. Guidelines for percutaneous transluminal coronary angioplasty: A report of the American College of Cardiology/American Heart Association Task Force on assessment of diagnostic and therapeutic cardiovascular procedures (Subcommittee on percutaneous transluminal coronary angioplasty).
J Am Coll Cardiol
 .
1988
;
12
:
529
–549
9
Chesebro
JH
, Knatterud G, Roberts R. Thrombolysis in myocardial infarction (TIMI) trial, Phase I: a comparison between intravenous tissue plasminogen activator and intravenous streptokinase*. Clinical findings through hospital discharge.
Circulation
 .
1987
;
76
:
142
–154
10
Braunwald
E
. Unstable angina. A classification.
Circulation
 .
1989
;
80
:
410
–414
11
Capone
G
, Wolf MM, Meyer B, Meister SG. Frequency of intracoronary filling defect by angiography in angina pectoris at rest.
Am J Cardiol
 .
1985
;
56
:
:403
–6
12
den Heyer
P
, Foley DP, Escaned J. Angioscopic versus angiographic detection of intimal dissection and intracoronary thrombus.
J Am Coll Cardiol
 .
1994
;
24
:
649
–654
13
N Engl J Med
 .
1997
;
336
:
1689
–1696
14
Circulation
 .
1997
;
96
:
1445
–1453
15
Lancet
 .
1997
;
349
:
1422
–1428
16
Muhlestein
JB
, Karagounis LA, Treehan S, Anderson JL. ‘Rescue’ utilization of abciximab for the dissolution of coronary thrombus developing as a complication of coronary angioplasty.
J Am Coll Cardiol
 .
1997
;
30
:
1729
–1734
17
Xue-Qiao
Zhao
, Snapinn S, Sax FL. Angiographic results from platelet receptor inhibition for ischemic syndrome management in patients with documented unstable angina or non Q wave MI (PRISM-plus) (Abstr).
Circulation
 .
1997
;
96
:
I-474
18
Ellis
SG
, Lincoff AM, Miller D. Reduction in complications of Angioplasty with Abciximab occurs largely independently of baseline lesion morphology.
J Am Coll Cardiol
 .
1998
;
32
:
1619
–1623
19
Kereiakes
D
, Lincoff AM, Miller DP. Abciximab therapy and unplanned coronary stent deployment. Favourable effects on stent use, clinical outcomes, and bleeding complications.
Circulation
 .
1998
;
97
:
857
–864
20
Lancet
 .
1998
;
352
:
87
–92
21
Anderson
HV
, Kierkeeide RL, Krishnaswami A. Cyclic flow variations after coronary angioplasty in humans: clinical and angiographic characteristics and elimination with 7E3 monoclonal antiplatelet antibody.
J Am Coll Cardiol
 .
1994
;
23
:
1031
–1037
22
Ellis
SG
, Vandormael MG, Cowley MJ. Coronary morphologic and clinical determinants of procedural outcome with angioplasty for multivessel coronary disease: Implications for patient selection.
Circulation
 .
1990
;
82
:
1193
–1202

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