Platelet glycoprotein llb/llla receptor inhibition as adjunctive treatment during saphenous vein graft stenting: differential effects after randomization to occlusion or filter-based embolic protection

摘要

Aims Although embolic protection devices reduce complications during saphenous vein graft (SVG) stenting, adverse events still occur in ~10% of patients, llb/llla antagonists have not been proven effective during SVG intervention. We hypothesized that adjunctive use of these agents might enhance the efficacy of embolic protection devices.Methods and results In the prospective, multicentre FilterWire EX Randomized Evaluation trial, 651 patients undergoing SVG stenting were randomized to either filter-based FilterWire EX or balloon occlusion/aspiration GuardWire embolic protection devices, llb/llla inhibitor use was at the discretion of the investigator, with randomization stratified by intended use. Patients pre-selected for llb/llla inhibitor use (n = 345) had higher baseline risk, with increased 30-day major adverse cardiac events (MACE, 13.0 vs. 8.0%, P = 0.03). GuardWire assigned patients treated with llb/llla inhibitors had higher 30-day MACE compared with those not treated with llb/llla inhibitors(16.0 vs. 6.3%, P = 0.007). In contrast, MACE in high-risk FilterWire patients treated with llb/llla inhibitors were similar to their lower risk, untreated counterparts (9.9 vs. 9.5%, P=0.89). Multivariable analysis detected a borderline significant (P = 0.056) interaction for lower MACE between FilterWire and lib/ Ilia inhibitor use. Adjustment by the propensity to use llb/llla inhibitors resulted in a significant (P= 0.023) interaction for lower MACE rates, llb/llla inhibition in conjunction with FilterWire was associated with less abrupt closure, no reflow, or distal embolization.Conclusion llb/llla antagonists may improve procedural outcome during SVG stenting in high risk patients, utilizing filter-based embolic protection devices.