Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor
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.
Fischman DL, Savage MP. Integrin β3 Blockade With Abciximab and Protection From Myocardial Ischemic Events—Reply. JAMA. 1998;279(3):195–196. doi:10.1001/jama.279.3.193
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