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Patient profiles, drug costs and other interventional alternatives are issues to consider when deciding who should receive this therapy.

While innovative techniques and catheters, including coronary stents, have dramatically improved success rates for nonsurgical coronary revascularization, complications following balloon angioplasty remain an important problem associated with mortality. An intravenous "super aspirin" called abciximab (ReoPro™, Centocor, Inc., Malvern, PA) administered in the catheterization laboratory before an angioplasty can prevent platelets from sticking to arterial walls and reclogging vessels after the procedure. Results of a multicenter study published in the August 13 issue of The Journal of the American Medical Association (JAMA) demonstrate a favorable effect on long-term outcome and survival in selected patients treated with ReoPro™.

In an editorial that accompanies the study, David L. Fischman, MD, associate professor of medicine, division of cardiology, Jefferson Medical College, Philadelphia, and associate director, cardiac catheterization laboratory at Thomas Jefferson University Hospital, recognizes the vast advantages of ReoPro™ but points out that patient profiles, drug costs and other interventional alternatives are issues to consider when deciding who should receive this "super aspirin."

In his editorial, Dr. Fischman notes that the multicenter study, which is a three-year follow-up to an initial study of ReoPro™, led by Eric J. Topol, MD, of the Cleveland Clinic Foundation, Ohio, shows that the benefits of ReoPro™ are greatest in the highest risk patients with acute heart attack or medically unstable angina. "The Topol study suggests a remarkable 60 percent reduction in mortality at three years in this select group treated with ReoPro™ compared with the group treated with placebo," said Dr. Fischman.

While pretreatment with ReoPro™ is highly effective, its average cost is estimated at $1,350 per patient dose. "The cost of this drug should bring significant attention to the question of who should receive it," said Dr. Fischman. "The issue of cost-effectiveness is vital to understanding whether or not ReoPro™ should be used in lower risk patient populations."

Dr. Fischman suggests that further investigation is necessary to address this issue. "Future development of oral agents similar to ReoPro™ promises to further expand the use of these agents to a broader spectrum of patients with ischemic heart disease," he said.

Michael P. Savage, M.D., associate professor of medicine, division of cardiology, Jefferson Medical College, and director of the cardiac catheterization laboratory at Thomas Jefferson University Hospital, contributed to the editorial.