Coronary artery bypass graft in abciximab-treated patients.

In an assessment of available literature regarding appropriate treatment algorithms for patients who fail cardiac interventions and require coronary bypass grafting with abciximab "on board," few surgeons reported significant variation in bleeding or other issues. There are many problems with postmarketing data collection, and such data would lack rigor and randomization. Prospective collection of data would be extremely difficult. Few patients go to surgery nowadays, and it is generally believed that because of the wealth of data supporting glycoprotein (GP) IIb/IIIa inhibition associated with percutaneous intervention, it would be unethical to subject patients to a placebo control in the catheterization laboratory. For those reasons, we returned to the clinical trials database and did a retrospective analysis of EPILOG and EPISTENT, the two studies that most appropriately reflect state-of-the-art intervention and abciximab use. We omitted EPIC, the original registration trial of high-risk angioplasty patients, because this study no longer reflects current recommendations regarding heparinization, abciximab administration, or groin care.