[Smoking cessation in hospitalised patients - Initiate among inpatients, continue when outpatients - A Position Paper by the German Respiratory Society (DGP) Taskforce for Smoking Cessation]. / Tabakentwöhnung bei hospitalisierten Patienten:innen ­ Stationär einleiten, ambulant fortführen.

Tobacco smoking is the greatest preventable health risk. The effects are serious, both individually and societal. Nevertheless, the current prevalence of tobacco smokers in Germany is still high at around 35 %. A recent strong increase in actively smoking adolescents (14- to 17-year-olds, current prevalence approx. 16 %) and young adults (18- to 24-year-olds, current prevalence approx. 41 %) is also a cause for concern. About a third of all inpatients continue smoking while being treated. The hospitalization of active smokers in acute and rehabilitation hospitals serves as a "teachable moment" for initiation of cessation offers. An intervention that begins in hospital and continues for at least a month after discharge results in about 40 % additional smokefree patients. It is scientifically well-researched, effective and cost-efficient. After initiation in hospital these measures can be continued via ambulatory cessation programs, rehabilitation facilities, an Internet or telephone service. In Germany, there are structured and quality-assured cessation offers, both for the inpatient and for the outpatient area. The biggest obstacle to broad establishment of such offers is the lack of reimbursement. Two feasible ways to change this would be the remuneration of the existing OPS 9-501 "Multimodal inpatient treatment for smoking cessation" and the establishment of quality contracts according to §â€Š110a SGB V. An expansion of tobacco cessation measures in healthcare facilities would reduce smoking prevalence, associated burden of disease and consecutive costs.

Walking activity during ambulant cardiac rehabilitation is related to maximum working capacity, age, and smoking behavior.

BACKGROUND: A total of 6,500 to 8,000 steps per day are recommended for cardiovascular secondary prevention. The aim of this research was to examine how many steps per day patients achieve during ambulant cardiac rehabilitation (CR), and if there is a correlation between the number of steps and physical and cardiological parameters. METHODS: In all, 192 stable CR patients were included and advised for sealed pedometry. The assessed parameters included maximum working capacity and heart rate, body mass index (BMI), New York Heart Association (NYHA) class, ejection fraction (EF), coronary artery disease status, beta-blocker medication, age, sex, smoking behavior, and laboratory parameters. A regularized regression approach called least absolute shrinkage and selection operator (LASSO) was used to detect a small set of explanatory variables associated with the response for steps per day. Based on these selected covariates, a sparse additive regression model was fitted. RESULTS: The model noted that steps per day had a strong positive correlation with maximum working capacity (P=0.001), a significant negative correlation with higher age (P=0.01) and smoking (smoker: P<0.05; ex-smoker: P=0.01), a positive correlation with high-density lipoprotein (HDL), and a negative correlation with beta-blockers. Correlation between BMI and walking activity was nonlinear (BMI 18.5-24: 7,427±2,730 steps per day; BMI 25-29: 6,448±2,393 steps/day; BMI 30-34: 6,751±2,393 steps per day; BMI 35-39: 5,163±2,574; BMI >40: 6,077±1,567). CONCLUSION: Walking activity during CR is reduced in patients who are unfit, older, smoke, or used to smoke. In addition to training recommendations, estimated steps per day during CR could be seen as a baseline orientation that helps patients to stay generally active or even to increase activity after CR.

Outcomes of transfemoral transcatheter aortic valve implantation at hospitals with and without on-site cardiac surgery department: insights from the prospective German aortic valve replacement quality assurance registry (AQUA) in 17 919 patients.

AIMS: Performing transcatheter aortic valve implantation (TAVI) at hospitals with only cardiology department but no cardiac surgery (CS) on-site is at great odds with current Guidelines. METHODS AND RESULTS: We analysed data from the official, prospective German Quality Assurance Registry on Aortic Valve Replacement to compare characteristics and in-hospital outcomes of patients undergoing transfemoral TAVI at hospitals with (n = 75) and without CS departments (n = 22). An interdisciplinary Heart Team was established at all centres (internal staff physicians at hospitals with on-site CS; in-house cardiologists and visiting cardiac surgical teams from collaborating hospitals at non-CS hospitals). In 2013 and 2014, 17 919 patients (81.2 ± 6.1 years, 55% females, German aortic valve (GAV) score 2.0 5.6 ± 5.8%, logistic EuroSCORE I 21.1 ± 15.4%) underwent transfemoral TAVI in Germany: 1332 (7.4%) at hospitals without on-site CS department. Patients in non-CS hospitals were older (82.1 ± 5.8 vs. 81.1 ± 6.1 years, P < 0.001), with more frequent co-morbidities. Predicted mortality risks per GAV-score 2.0 (6.1 + 5.5 vs. 5.5 ± 5.9%, P < 0.001) and logEuroSCORE I (23.2 ± 15.8 vs. 21.0 ± 15.4%, P < 0.001) were higher in patients at non-CS sites. Complications, including strokes (2.6 vs. 2.3%, P = 0.452) and in-hospital mortality (3.8 vs. 4.2%, P = 0.396), were similar in both groups. Matched-pair analysis of 555 patients in each group with identical GAV-score confirmed similar rates of intraprocedural complications (9.2 vs. 10.3%, P = 0.543), strokes (3.2% for both groups, P = 1.00), and in-hospital mortality (1.8 vs. 2.9%, P = 0.234). CONCLUSION: Although patients undergoing TAVI at hospitals without on-site CS department were older and at higher predicted perioperative death risk, major complications, and in-hospital mortality were not statistically different, suggesting the feasibility and safety of Heart Team-based TAVI at non-CS sites. These findings need confirmation in future randomized study.

Timing of percutaneous coronary intervention in troponin-negative patients with acute coronary syndrome without persistent ST-segment elevation: preliminary results and status quo in German chest pain units.

OBJECTIVE: Management of acute coronary syndromes without persistent ST-segment elevation (NSTE-ACS) and unstable angina pectoris (UAP) remains challenging. The study aimed to analyze the current management of UAP patients in German chest pain units focussing on the different time lines of invasive strategy. METHODS: A total of 1400 UAP patients admitted to a certified chest pain unit were enrolled. Analyses of high-risk criteria with indication for invasive management and of 3-month clinical outcomes were performed by subgrouping UAP patients to immediate and early invasive (<8 hours), early elective invasive (8-24 hours), late elective invasive (24-72 hours) strategy, and without percutaneous coronary intervention (PCI). RESULTS: Coronary angiography was performed in 60.6% of the UAP patients, whereas PCI was necessary in 37%. Only 1.4% of the UAP patients obtained immediate PCI within the first 120 minutes. In 16.9%, patients received PCI within the first day of hospitalization or even within the first 8 hours after admission in another 7.7%, although the Global Registry of Acute Coronary Events (GRACE) score at admission was below 140. In the remaining 12.4% of the UAP patients, PCI was performed within 24-72 hours after admission. Those patients exhibited a higher prevalence of secondary risk markers than those with conservative treatment regimen. CONCLUSIONS: To date, almost two-third of UAP patients at intermediate to high risk receive rapid invasive regimen within the first 24 hours after admission. Oncoming studies will have to analyze its overall guideline-adherence and resulting differences in major adverse events.

Disease distribution and outcome in troponin-positive patients with or without revascularization in a chest pain unit: results of the German CPU-Registry.

OBJECTIVES: The aim of this analysis was to compare troponin-positive patients presenting to a chest pain unit (CPU) and undergoing coronary angiography with or without subsequent revascularization. Leading diagnosis, disease distribution, and short-term outcomes were evaluated. BACKGROUND: Chest pain units are increasingly implemented to promptly clarify acute chest pain of uncertain origin, including patients with suspected acute coronary syndrome (ACS). METHODS: A total of 11,753 patients were prospectively enrolled into the German CPU-Registry of the German Cardiac Society between December 2008 and April 2011. All patients with elevated troponin undergoing a coronary angiography were selected. Three months after discharge a follow-up was performed. RESULTS: A total of 2,218 patients were included. 1,613 troponin-positive patients (72.7 %) underwent a coronary angiography with subsequent PCI or CABG and had an ACS in 96.0 %. In contrast, 605 patients (27.3 %) underwent a coronary angiography without revascularization and had an ACS in 79.8 %. The most frequent non-coronary diagnoses in non-revascularized patients were acute arrhythmias (13.4 %), pericarditis/myocarditis (4.5 %), decompensated congestive heart failure (3.7 %), Takotsubo cardiomyopathy (2.7 %), hypertensive crisis (2.4 %), and pulmonary embolism (0.3 %). During the 3-month followup, patients without revascularization had a higher mortality (12.1 vs. 4.5 %, p<0.0001) representing the major contributor to the higher rate of MACCE (15.1 vs. 8.1 %, p<0.001). These data were confirmed in a subgroup analysis of ACS patients with or without revascularization. CONCLUSIONS: Patients presenting to a CPU with elevated troponin levels mostly suffer from ACS and in a smaller proportion a variety of different diseases are responsible. The short-term outcome in troponin-positive patients with or without an ACS not undergoing a revascularization was worse, indicating that these patients were more seriously ill than patients with revascularization of the culprit lesion. Therefore, an adequate diagnostic evaluation and improved treatment strategies are warranted.

Emergent cardiac surgery during transcatheter aortic valve implantation (TAVI): a weighted meta-analysis of 9,251 patients from 46 studies.

AIMS: Transcatheter aortic valve implantation (TAVI) is a novel treatment option for high surgical risk patients with severe symptomatic aortic valve (AV) stenosis. During TAVI, some patients may require emergent cardiac surgery (ECS). However, the incidence, reasons and outcomes of those needing ECS remain unknown. METHODS AND RESULTS: We performed a search of the English medical literature using MEDLINE to identify all studies on TAVI and evaluate the incidence of ECS (i.e., within 24 hrs of TAVI) and outcomes for these patients. Forty-six studies comprising 9,251 patients undergoing transfemoral, transapical or trans-subclavian TAVI for native AV stenosis published between 01/2004 and 11/2011 were identified and included in this weighted meta-analysis. Overall, TAVI patients were old (mean=81.3±5.4 years) and had a high mean logistic EuroSCORE (24.4±5.9%). Few patients required ECS (n=102; 1.1±1.1%) and this was marginally higher among those undergoing transapical TAVI as compared to those undergoing transarterial TAVI (1.9±1.7% vs. 0.6±0.9%). Data on the reasons for ECS were available in 86% (88/102 patients) and 41% of these (36/88) were performed for embolisation/dislocation of the AV prosthesis, with aortic dissection (n=14), coronary obstruction (n=5), severe AV regurgitation (n=10), annular rupture (n=6), aortic injury (n=14), and myocardial injury including tamponade (n=12) constituting the rest. Mortality at 30 days was about 9-fold higher in patients who did need as compared with those patients who did not need ECS (67.1±37.9% vs. 7.5±4.0%). CONCLUSIONS: Reported rates of ECS during TAVI were low with embolisation or dislocation of the prosthesis being the most common cause. ECS was associated with grave prognosis with two out of three patients dying by 30 days. Thus, refinement in TAVI technology should not only focus on miniaturisation and improving flexibility of the delivery systems and/or devices -which may have the potential for decreasing aortic dissection, annular rupture, and tamponade- but also incorporate modifications to prevent embolisation/dislocation of the valve.

Self-referral to chest pain units: results of the German CPU-registry.

BACKGROUND: Chest pain units (CPUs) are increasingly established in emergency cardiology services. With improved visibility of CPUs in the population, patients may refer themselves directly to these units, obviating emergency medical services (EMS). Little is known about characteristics and outcomes of self-referred patients, as compared with those referred by EMS. Therefore, we described self-referral patients enrolled in the CPU-registry of the German Cardiac Society and compared them with those referred by EMS. METHODS AND RESULTS: From 2008 until 2010, the prospective CPU-registry enrolled 11,581 consecutive patients. Of those 3789 (32.7%) were self-referrals (SRs), while 7792 (67.3%) were referred by EMS. SR-patients were significantly younger (63.6 vs. 70.1 years), had less prior myocardial infarction or coronary artery bypass surgery, but more previous percutaneous coronary interventions (PCIs). Acute coronary syndromes were diagnosed less frequently in the SR-patients (30.3 vs. 46.9%; p<0.0001). SR-patients showed ST-segment changes in their initial ECG in 19.6% of cases. EMS-patients underwent more coronary angiographies (60.0 vs. 47.5%; p<0.0001), while SR-patients underwent more stress tests (11.3 vs. 7.8%; p<0.001). PCI was performed in 32.6% of the EMS- and in 24.0% of the SR-group (p<0.0001). CONCLUSION: These data demonstrate that patients who contact a CPU as a self-referral are younger, less severely ill and have more non-coronary problems than those calling an emergency medical service. Nevertheless, 30% of self-referral patients had an acute coronary syndrome.

The adverse events and hemodynamic effects of adenosine-based cardiac MRI.

OBJECTIVE: We wanted to prospectively assess the adverse events and hemodynamic effects associated with an intravenous adenosine infusion in patients with suspected or known coronary artery disease and who were undergoing cardiac MRI. MATERIALS AND METHODS: One hundred and sixty-eight patients (64 ± 9 years) received adenosine (140 µg/kg/min) during cardiac MRI. Before and during the administration, the heart rate, systemic blood pressure, and oxygen saturation were monitored using a MRI-compatible system. We documented any signs and symptoms of potential adverse events. RESULTS: In total, 47 out of 168 patients (28%) experienced adverse effects, which were mostly mild or moderate. In 13 patients (8%), the adenosine infusion was discontinued due to intolerable dyspnea or chest pain. No high grade atrioventricular block, bronchospasm or other life-threatening adverse events occurred. The hemodynamic measurements showed a significant increase in the heart rate during adenosine infusion (69.3 ± 11.7 versus 82.4 ± 13.0 beats/min, respectively; p < 0.001). A significant but clinically irrelevant increase in oxygen saturation occurred during adenosine infusion (96 ± 1.9% versus 97 ± 1.3%, respectively; p < 0.001). The blood pressure did not significantly change during adenosine infusion (systolic: 142.8 ± 24.0 versus 140.9 ± 25.7 mmHg; diastolic: 80.2 ± 12.5 mmHg versus 78.9 ± 15.6, respectively). CONCLUSION: This study confirms the safety of adenosine infusion during cardiac MRI. A considerable proportion of all patients will experience minor adverse effects and some patients will not tolerate adenosine infusion. However, all adverse events can be successfully managed by a radiologist. The increased heart rate during adenosine infusion highlights the need to individually adjust the settings according to the patient, e.g., the number of slices of myocardial perfusion imaging.

Comparison of prognostic usefulness (three years) of computed tomographic angiography versus 64-slice computed tomographic calcium scanner in subjects without significant coronary artery disease.

Coronary computerized tomographic angiography (CTA) has been used as a noninvasive method for ruling out high-grade stenoses. Even in the absence of such stenoses, analysis of coronary atherosclerosis may provide for important prognostic information, and this may be superior to exclusive coronary artery calcium scoring. We tested this hypothesis in patients undergoing CTA for clinical indications who had no stenoses requiring revascularization. From December 2004 to December 2006, 706 consecutive patients who underwent CTA but had no high-grade stenoses were included (58% men, mean age 59 ± 11 years). CTA and coronary artery calcium scoring (Agatston method) were performed using a 64-slice CT scanner with a gantry rotation time of 330 ms. CT angiograms were categorized as completely normal (group 1), showing minor plaque (group 2), or showing intermediate stenoses (group 3). Follow-up information was obtained in 670 patients (95%) over a mean of 3.2 years. There were 31 major adverse events (5%), namely 9 deaths (all noncoronary), 2 myocardial infarctions, 5 strokes, 13 coronary revascularization procedures (percutaneous or surgical > 6 months after CTA), and 2 peripheral percutaneous interventions. Coronary status as defined by CTA was predictive of major events after adjustment for age and gender. In group 1, the probability of event-free survival at 3 years was 100%; in group 2, it was 96%; and in group 3, it was 91%. Compared to group 1, the risk in group 2 was increased 2.3-fold, and in group 3, it was increased 5.6-fold after adjusting for age and gender. However, after addition of the coronary artery calcium score to the regression analysis, CT angiographic status no longer appeared to be predictive. In conclusion, the risk of a major adverse cardiovascular event or death increased in a graded manner with degree of coronary atherosclerosis as defined by CTA even in the absence of high-grade coronary stenoses. However, in the absence of high-grade stenoses, we were unable to demonstrate a superior prognostic value of CTA compared to coronary artery calcium.

Coronary calcification in patients with marker-positive acute coronary syndrome.

BACKGROUND: The value of assessing coronary artery calcium (CAC) with regard to characterizing unstable coronary artery disease remains controversial. PURPOSE: To evaluate the amount of CAC in patients with an acute marker-positive coronary syndrome in segments containing the culprit lesion compared with the remote coronary segments. MATERIAL AND METHODS: Thirty-two patients with a marker-positive acute coronary syndrome were examined using electron-beam computed tomography (EBCT), selective coronary angiography and, in some, intravascular ultrasound. The coronary anatomy was analyzed according to the segmental classification proposed by the American Heart Association (AHA). RESULTS: The total EBCT coronary artery calcium score (CAC, Agatston method) was 251±371 (range 0-1629). In 81% of the patients, a greater CAC score was observed than expected on the basis of age and gender. In 30 patients, significant stenoses were detected. The CAC score of the culprit vessel was 108±163 vs 78±134 in the non-culprit vessels and did not differ significantly (P=0.4). The mean CAC score of the coronary segment (AHA classification) containing the culprit lesion was 51±82 vs 29±45 in the other coronary artery segments (P=0.14). Of the two patients with no CAC detected by EBCT, one had no coronary atherosclerosis (confirmed by intravascular ultrasound) and one had one vessel coronary artery disease. CONCLUSION: Coronary calcium related to the culprit lesion in patients with a marker-positive acute coronary syndrome showed a tendency for an increased amount but was not statistically different from the amount of coronary calcium in remote vessel segments.

Coronary artery calcium scoring: influence of reconstruction interval and reconstruction increment using 64-MDCT.

OBJECTIVE: Assessment of coronary artery calcification is increasingly used for cardiovascular risk stratification. However, a scanning protocol for modern MDCT has not been established. In this study, we evaluated the impact of the reconstruction interval within diastole and the reconstruction increment on the coronary calcium score. MATERIALS AND METHODS: In 40 consecutive patients Agatston scores and volumetric scores were assessed using a 64-MDCT scanner. The patients were assigned to two groups at random with 20 patients each: in group A, collimation was 64 x 0.6 mm; in group B, it was 20 x 1.2 mm. All CT examinations were performed with retrospective ECG gating. For each patient, five data sets were created throughout diastole (50%, 55%, 60%, 65%, and 70% of the R-R interval). For each reconstruction, two data sets were calculated with a reconstruction increment of 3.0 and 1.5 mm, respectively. For all reconstructions, the mean Agatston scores and volumetric scores +/- SD and the coefficient of variance were assessed. Furthermore, for each reconstruction, patients were assigned a percentile rank that described the level of cardiovascular risk. RESULTS: Four patients had to be excluded from the study because no coronary calcium was detected on any of the reconstructions. In both groups, the mean Agatston score was not significantly different between reconstruction increment 3.0 mm and reconstruction increment 1.5 mm (group A, 112.1 +/- 92.5 and 114.3 +/- 93.6, p = 0.28; group B, 164.8 +/- 203.0 and 169.4 +/- 207.9, p = 0.29, respectively). However, in two cases, very small calcified lesions in the circumflex coronary artery were only detected using a reconstruction increment of 1.5 mm. In both groups, the mean coefficient of variation was not significantly different at reconstruction increment 1.5 mm (group A, 11.4 +/- 8.2; group B, 12.5 +/- 7.6) and reconstruction increment 3.0 mm (group A, 14.8 +/- 9.3; group B, 14.2 +/- 9.1; group A, p = 0.18; group B, p = 0.48). Based on the reconstruction increment and reconstruction interval, 77% of the patients (n = 14) in group A were assigned to one risk group and 23% (n = 4) to two different risk groups according to percentile strata. In group B, 83% of the patients (n = 15) were assigned to one risk group and 17% (n = 3) to two different risk groups. In contrast to the Agatston score, the volumetric score was significantly higher in both groups at reconstruction increment 1.5 mm (group A, 105.4 +/- 78.5 mm3; group B, 153.8 +/- 182.5 mm3) compared with reconstruction increment 3.0 mm (group A, 90.0 +/- 73.11 mm3; group B, 138.2 +/- 166.8 mm3; p < 0.05). CONCLUSION: Using a 64-MDCT scanner, the calcium score calculated from different reconstructions within early diastole is variable, but the difference can be minimized using overlapping slice reconstructions. The variation does not lead to a different risk estimation in most patients. In patients with mild coronary calcifications, the use of overlapping slices may help to detect small calcified plaques. Furthermore, we recommend the use of ECG-controlled tube current modulation to reduce the radiation exposure.

Limited flow reserve in non-obstructed bypass grafts supplying infarcted myocardium: implications for cardiovascular magnetic resonance imaging protocols.

We evaluated flow reserve in non-obstructed bypass grafts supplying infarcted and noninfarcted myocardium. Bypass grafts were examined by phase-contrast flow measurements and myocardial viability was assessed with late enhancement technique. Flow reserve was higher in bypasses supplying normal myocardium compared to those supplying infarcted myocardium (2.9 vs. 1.5, p<.0001). This difference remained significant after adjusting for co-variables. Bypass grafts supplying infarcted myocardium were more likely to have lower flow reserve than those supplying normal myocardium (flow reserve < or =2, 84% vs 18%, p = .0003). Flow reserve is reduced in non-stenosed bypasses supplying infarcted myocardium, likely due to altered microcirculation. Thus, cardiovascular magnetic resonance based bypass assessment must include myocardial viability testing.

[Possibilities and prospects of noninvasive bypass diagnosis. Comparison of different nuclear magnetic resonance tomography methods with conventional coronary angiography]. / Möglichkeiten und Perspektiven der nichtinvasiven Bypassdiagnostik. Vergleich verschiedener kernspintomographischer Methoden mit der konventionellen Koronarangiographie.

OBJECTIVE: The aim of the study was to evaluate the patency of coronary artery bypass grafts (CABGs) with different MR imaging techniques. PATIENTS: 25 patients with 63 bypass grafts and a total of 78 distal anastomoses were studied at a 1.5-Tesla scanner. A 2-D T2-weighted breath-hold turbo spin echo sequence (Haste), a 3-D breath-hold contrast-enhanced MR angiography sequence (Fisp-3-D), and 3-D angiography sequence in navigator techniques were used. RESULTS: With the Haste and Fisp-3-D sequences, 44 of the 47 patent and 14 of the 16 occluded grafts were recognized, the sensitivity and specificity were 94% and 88%, respectively. With the Haste sequence, 80% (43/54) of the distal anastomoses were seen in good image quality, and with the Fish-3-D sequence 70% (38/54). The navigator sequence showed less sensitivity and specificity (74% and 63%, respectively). CONCLUSION: The patency of CABGs can be evaluated noninvasively with the Haste and the Fisp-3-D angiography sequences. Better results can be expected with the development of a blood-pool contrast medium and an improvement of the spatial resolution.

Comparison of ReoPro((R)) (abciximab) versus intracoronary thrombolysis for early coronary stent thrombosis.

AIMS: This study evaluated the treatment of early coronary stent thrombosis with intracoronary urokinase or the platelet glycoprotein IIb/IIIa receptor inhibitor ReoPro (abciximab). METHODS AND RESULTS: Seventy-four patients (126 stents) were treated immediately after identification of early (0-30 days) coronary stent thrombosis. Twenty-nine patients were treated with intracoronary urokinase (UK) (UK alone in 19; UK and additional balloon angioplasty in 10) and another 45 patients were given ReoPro((R)) (abciximab) (0.25 mg/kg as a bolus alone in 26, abciximab with additional balloon angioplasty in 19) within 30 days of stent implantation. TIMI grade 3 flow was obtained in 23 patients (79%) in the UK group and in 38 (84%) in the abciximab group (nonsignificant). Three patients (10%) in the UK group and one (2%) in the abciximab group underwent repeat percutaneous transluminal coronary angioplasty (PTCA) (nonsignificant). Five patients (17%) in the UK group and three (7%) in the abciximab group were referred for urgent coronary artery bypass graft surgery (CABG) because of residual thrombus and refractory ischemia (nonsignificant). Repeat revascularization was necessary in eight patients (28%) in the UK group versus four (9%) in the abciximab group (p < 0.05). Five patients (17%) in the UK group and eight (18%) in the abciximab group developed myocardial infarction (nonsignificant). Five patients (17%) in the UK group (cardiogenic shock (three), cerebral hemorrhage (one) and pneumonia (one)) and three (6.6%) in the abciximab group (cardiogenic shock (two), heart failure (one)) died within 30 days (nonsignificant). Overall, noncardiac complications (bleeding including surgical repair of groin) were observed in 11 patients (38%) in the UK group and three (7%) in the abciximab group (p < 0.001). CONCLUSION: Compared to urokinase, abciximab reduced the need for repeat revascularization procedures and the risk of noncardiac events, including bleeding complications in patients with early coronary stent thrombosis.