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January 21, 1998

Integrin β3 Blockade With Abciximab and Protection From Myocardial Ischemic Events—Reply

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;279(3):195-196. doi:10.1001/jama.279.3.193

In Reply.—Dr Conrad and associates cite an interesting mechanism by which integrin β3 blockade by abciximab may result in a protective effect from ischemic events. As is pointed out in the article by Topol et al,1 the benefit achieved with abciximab was unexpected at the longer-term follow-up. Perhaps a reduction in free radical formation by impairment of iron uptake into cells results in a reduction in oxidation of lipids in low-density lipoprotein, thereby stabilizing atherosclerotic plaque and preventing late atherosclerotic events. Whether the brief exposure to this agent, however, results in the improved long-term outcome based on this hypothesis is speculative. The improved longer-term outcome appears to be related primarily to a reduction in acute ischemic events, which is a platelet-mediated event.2 Interestingly, 2 subsequent studies, EPILOG3 and CAPTURE,4 which confirmed the reduction in early adverse events with abciximab, did not demonstrate the improved late outcome as seen in the EPIC trial.