Abciximab

Angioplasty, a procedure in which a tiny balloon is inserted into a blocked coronary artery and then inflated to open it, can make more invasive heart surgery unnecessary Each year, about 500,000 people in the United States undergo this procedure. Yet nearly half of them have another angioplasty or even bypass surgery because their arteries either clog again or narrow due to scar tissue formation (SN: 6/14/97, p. 364).

Now, research indicates that two drugs, one new and one old, can limit these problems.

In 2,099 high-risk patients who underwent angioplasty, the new drug abciximab lowered the rate of death, heart attack, or repeat angioplasty by 19 percent in the first year and by 13 percent in the first 3 years, researchers at the Cleveland Clinic Foundation report in the Aug. 13 Journal of the American Medical Association. Abciximab was given intravenously for the 12 hours preceding the procedure.

Abciximab keeps blood platelets from aggregating, says Cleveland Clinic cardiologist A. Michael Lincoff, who notes that clotting is the major risk patients face immediately after angioplasty. The drug costs roughly $1,350 per patient, however.

In a Canadian study of nonemergency patients, researchers tested the effectiveness of the antioxidant drug probucol in combating restenosis, the narrowing of blood vessels caused by scar tissue buildup after angioplasty. Of 317 patients, some received probucol for 1 month before and 6 months after angioplasty. Others took extra vitamins C and E, some took both the vitamins and probucol, and some received inactive pills.

Probucol--once used to lower cholesterol but since abandoned by its maker, Hoechst Marion Roussel--reduced by 50 percent the rate of restenosis among angioplasty patients during the 6 months following the procedure. Those getting probucol and vitamins fared better than those not receiving probucol at all, but they did worse than the probucol--only group, researchers at the Montreal Heart Institute report in the Aug. 7 New England Journal of Medicine.

Only 11 percent of the patients getting probucol alone needed a repeat angioplasty after a year, compared to more than 25 percent of those getting no probucol.

In an editorial accompanying the study, Peter Libby and Peter Ganz of Brigham and Women's Hospital in Boston suggest that probucol may interrupt oxidant-sensitive signaling systems in the body and mitigate the arterial inflammation caused by inflating the balloon. This could lessen restenosis. Because the probucol treatment begins 1 month before surgery, its use is limited to patients having a planned rather than an emergency angioplasty, they note.

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