Reduction in periprocedural enzyme elevation by abciximab after rotational atherectomy of type B₂ lesions: Results of the Rota ReoPro randomized trial

Background: Abciximab has been shown to reduce ischemic complications and creatine kinase-myocardial band (CK-MB) elevation of both simple and complex coronary interventions. In addition to the procedural complications, one of the important mechanisms for CK-MB elevation after rotational atherectomy is an interaction between platelets and the atheromatous debris. Methods: This study was conducted to determine whether abciximab would limit the extent of periprocedural CK-MB release after rotational atherectomy of American Heart Association/American College of Cardiology type B₂ lesions in a double-blind, randomized, placebo-controlled manner. A total of 100 lesions in 100 patients were randomized with the primary end point being a CK-MB elevation of > 16 U/L. Results: Procedural success was achieved in 100% in the abciximab arm compared with 98% in the placebo group with any CK-MB elevation > 16 U/L of 8% in the abciximab versus 22% in the placebo group (P =. 04). The peak creatine phosphokinase level (units per liter) was 102 ± 14 versus 153 ± 22 (P =. 05) and the peak CK-MB level was 12.8 ± 1.8 versus 24.6 ± 3.5 (P =. 06) between the abciximab and placebo groups, respectively. Slow-flow or postprocedure chest pain occurred in 14% in the abciximab group versus 30% in the placebo group (P =. 04). There was 1 Q-wave myocardial infarction in the placebo arm and 1 nonhemorrhagic stroke in the abciximab group. Conclusions: Therefore the Rota ReoPro randomized trial revealed the benefit of abciximab during rotational atherectomy in reducing procedural morbidity and CK-MB elevation, and its routine use can be justified even in moderately complex lesions undergoing rotational atherectomy.