804-1 Heparin Pretreatment May Confer Additional Benefit in Patients Treated with 7E3 and PTCA for Unstable Coronary Syndromes

Patients undergoing percutaneous intervention for unstable coronary syndromes associated with coronary thrombus are at substantially increased risk of ischemic complications. The incidence of ischemic complications in the EPIC trial was reduced in this subgroup (n=893) by treatment with the chimeric monoclonal anti-IIb/IIIa antibody 7E3. We assessed the clinical effects of heparin pretreatment in this group. Data were available for 855 patients of whom 583 received 7E3 bolus or bolus and infusion. Of these, 383 (66%) were pretreated with heparin for a mean 55 hours [interquartile range 21, 96]. Outcomes examined included the primary 30 day composite end-point (death, non-fatal infarction, CABG, repeat percutaneous intervention for acute ischemia) components thereof and major bleeding events.PretreatmentHeparin (n=383)No heparin (n=200)Odds ratio (95% CI)Primary endpoint30 (7.8%)25 (12.5%)1.7 (0.9, 2.9)Repeat percutaneous intervention or CABG11 (2.9%)10 (5.0%)1.8 (0.7, 4.3)Myocardial infarction14 (3.7%)13 (6.5%)1.8 (0.8, 4.0)Major bleeding event20 (5.2%)14 (7.0%)1.3 (0.7, 2.8)There was a strong trend toward further reduction of ischemic endpoints when patients received heparin pretreatment in addition to 7E3. This effect was not associated with an increased incidence of significant bleeding. These data support further investigation of the potentially additive roles of anti-platelet and anti-thrombotic treatments as adjuncts to percutaneous intervention in unstable coronary syndromes