This study evaluated the effect of the glycoprotein IIb/IIIa (GPIIb/IIIa) antagonist
abciximab on myocardial hypoperfusion during percutaneous transluminal rotational
PTRA may cause transient ischemia and periprocedural myocardial injury. A platelet-dependent
risk of non-Q-wave infarctions after directional atherectomy has been described. The
role of platelets for the incidence and severity of myocardial hypoperfusion during
PTRA is unknown.
Seventy-five consecutive patients with complex lesions were studied using resting
Tc-99m sestamibi single-photon emission computed tomography prior to PTRA, during,
and 2 days after the procedure. The last 30 patients received periprocedural abciximab
(group A) and their results were compared to the remaining 45 patients (group B).
For semiquantitative analysis, myocardial perfusion in 24 left ventricular regions
was expressed as percentage of maximal sestamibi uptake.
Baseline characteristics did not differ between the groups. Transient perfusion defects
were observed in 39/45 (87%) patients of group B, but only in 10/30 (33%) patients
of group A (p < 0.001). Perfusion was significantly reduced during PTRA in 3.3 +/-
2.5 regions in group B compared to 1.4 +/- 2.5 regions in group A (p < 0.01). Perfusion
in the region with maximal reduction during PTRA in groups B and A was 76 +/- 15%
and 76 +/- 15% at baseline, decreased to 56 +/- 16% (p < 0.001) and 67 +/- 14%, respectively,
during PTRA (p < 0.01 A vs. B), and returned to 76 +/- 15% and 80 +/- 13%, respectively,
after PTRA. Nine patients in group B (20%) and two patients in group A (7%) had mild
creatine kinase and/or troponin t elevations (p = 0.18). Patients with elevated enzymes
had larger perfusion defects than did patients without myocardial injury (4.2 +/-
2.7 vs. 2.3 +/- 2.5 regions, p < 0.05).
These data indicate that GPIIb/IIIa blockade reduces incidence, extent and severity
of transient hypoperfusion during PTRA. Thus, platelet aggregation may play an important
role for PTRA-induced hypoperfusion.