March 30, 2008

Anticoagulant Drugs Had Similar Outcomes After Angioplasty

SUNDAY, March 30 (HealthDay News) -- In heart attack patients who had angioplasty, the anticoagulant drugs abciximab and tirofiban produced similar outcomes for certain cardiac measures within 90 minutes after the procedure, says an Italian study.

The researchers also found that patients who received coated stents that released the drug sirolimus had a lower risk of major adverse cardiac events within eight months than patients who received uncoated stents.

The study was to be presented Sunday at the American College of Cardiology annual meeting in Chicago. It was also to be published online Sunday in the Journal of the American Medical Association and will appear in the April 16 print issue.

Treatment with abciximab and implantation of an uncoated stent is a treatment strategy used to reduce the risk of major adverse cardiac events (MACE) in patients undergoing angioplasty for ST-segment elevation myocardial infarction (STEMI - a certain pattern on an electrocardiogram after a heart attack), according to background information in the study.

The researchers noted it hasn't been clear whether using tirofiban instead of abciximab would provide similar benefits. They added that the use of drug-eluting stents instead of uncoated stents in this patient population is discouraged because of safety concerns and conflicting evidence about efficacy.

In this study, Dr. Marco Valgimigli, of the Cardiovascular Institute at the University of Ferrara, and his colleagues compared high-dose tirofiban and sirolimus-releasing stents with abciximab infusion and uncoated stents in 745 patients with STEMI undergoing angioplasty. They found that ST-segment elevation was reduced by at least 50 percent within 90 minutes after angioplasty in 83.6 percent of patients in the abciximab group and in 85.3 percent of those in the tirofiban group.

At eight months, the MACE rate among those treated with tirofiban was 9.9 percent, compared to 12.4 percent in the abciximab group. The MACE rate among patients who received uncoated stents was 14.5 percent, compared with 7.8 percent among those who received the drug-releasing stent. The rate of revascularization (a repeat procedure to unblock a blood vessel) was 3.2 percent among patients who received the drug-coated stent, compared with 10.2 percent among patients who received an uncoated stent.

"In summary, our study provides evidence that in a broad population of largely unselected patients undergoing PCI for STEMI, tirofiban therapy is associated with a noninferior resolution from ST-segment elevation at 90 minutes post-intervention compared with abciximab, and at eight-month follow-up, MACE are approximately halved by sirolimus-eluting stent implantation compared with uncoated stents," the study authors wrote.

More information

The U.S. National Heart, Lung, and Blood Institute has more about angioplasty.

-- Robert Preidt
SOURCES: JAMA/Archives journals, news release, March 30, 2008
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