Jeffrey J. Popma

711-3-A Multicenter, Randomized, Double-Blind Pilot Trial of Standard Versus Low Dose Weight-Adjusted Heparin in Patients Treated with the Platelet GP IIb/IIIa Receptor Antibody c7E3 During Percutaneous Coronary Revascularization

Blockade of the platelet GP IIb/IIIa receptor by the monoclonal antibody c7E3 during high-risk coronary intervention reduced the 30-day endpoint of death, MI, or urgent revascularization by 35% in the EPIC trial, but was accompanied by an increase in the rate of major bleeding. In EPIC, heparin was administered as non-weight adjusted bolus doses to a therapeutic activated clotting time (ACT): bleeding increased with maximal in-lab ACT and relative heparin dose. To evaluate the safety and efficacy of weight-adjusted heparin dosing during c7E3 administration (0.25xa0mg/kg bolus, 10xa0mcg/min infusionxa0×xa012xa0hrs). 103 pts undergoing coronary intervention were randomized to 1 of 2 regimens of heparin in a blinded fashion: 100xa0U/kg bolusxa0+xa0additional doses to achieve ACTxa0>xa0300xa0sec (Standard Dose, nxa0=xa051), or 70xa0U/kg bolus without ACT adjustment (Low Dose, nxa0=xa052). ACT values immediately prior to intervention (median and interquartile range) and bleeding complications (unrelated to CABG) during the first 36xa0hrs (compared to 708 EPIC pts receiving same c7E3 dose). femoral hematomaxa0>xa05xa0cm in size, and in-hospital death or MI were: n n n n n n EPIC Non Wt-Adjusted Standard Wt-Adjusted Low Wt-Adjusted n Heparin Heparin Heparin nACT (sec) 398 330 257 n(25th, 75th) (356,468) (308,374) (229,288) nMajor bleeds xa07.8% xa01.9% xa02.0% nMinor bleeds 17.9% xa07.7% xa07.8% nHematoma N/A 15.4% xa03.9% nTransfusions xa015.5% xa07.7% xa02.0% n nFull-size table n nTable options n n n nView in workspace n nDownload as CSV n n n n n n n n n n n n n n n nFigure options n n n nDownload full-size image nDownload high-quality image (51 K) nDownload as PowerPoint slide n n n n n n n nThus, reduced weight-adjusted heparin dosing with c7E3 antiplatelet therapy during coronary intervention in this pilot study did not increase ischemic events, and at the same time appeared to decrease bleeding complications. Weight-adjusted heparin strategies will be further tested in a large-scale, randomized trial (EPILOG).

HIGH-RISK PERCUTANEOUS CORONARY INTERVENTION RESULTS IN SUBSTANTIAL REVERSE REMODELING OF THE LEFT VENTRICLE IN ISCHEMIC CARDIOMYOPATHY

Reverse left ventricular (LV) remodeling is associated with decreased clinical events.nnThe PROTECT II study was a multicenter trial of high-risk percutaneous coronary intervention (PCI) with hemodynamic support randomized to Impella 2.5 or intra-aortic balloon pump (IABP) in patients with ischemic

Practical integration of intravascular ultrasound imaging into the cardiac catheterization laboratory

By carefully analyzing the catheterization laboratory environment, it is possible to establish a program that facilitates clinical IVUS imaging without adding significant (i.e., more than 5 minutes) to the interventional procedure. This has resulted in the exponential growth of the program. It is currently being used to guide approximately 75% of the interventional procedures we perform. The other limitations to the routine use of IVUS (procedural cost and physician education) will require different solutions.