J Thorac Cardiovasc Surg 2006;131:266-267
© 2006 The American Association for Thoracic Surgery
Division of Cardiothoracic Surgery, Beth IsraelDeaconess Medical Center, Boston, Mass.
Received for publication October 10, 2005; revisions received October 13, 2005; accepted for publication October 19, 2005. * Address for reprints: Frank W. Sellke, MD, Division of Cardiothoracic Surgery, LMOB Suite 2A, Beth IsraelDeaconess Medical Center, 110 Francis St, Boston, MA 02215. (Email: firstname.lastname@example.org).
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In this issue of the Journal, Carrier and colleagues 1 report on a subgroup analysis of the PRIMO-CABG study, * in which patients undergoing combined coronary artery bypass grafting (CABG) and aortic valve replacement receive either placebo or the complement C5-binding monoclonal antibody pexelizumab. The initial phase II prospective multicenter trial on the use of pexelizumab during coronary and valve surgery in 914 patients 2 found no significant effect on mortality. Post hoc analysis, however, suggested that for isolated CABG, pexelizumab did reduce death or myocardial infarction. Some of the same investigators published the benefit of pexelizumab on cognitive decline and stroke after CABG. The authors reported no differences, except for a slight improvement in the visuo-spatial domain. 3 The PRIMO-CABG study was a multi-institutional, randomized trial evaluating a complement C5-binding monoclonal antibody in 3099 cardiac surgery patients with regard to combined mortality or myocardial infarction. The primary end point within 30 days after surgery was reduced by about 20% in patients with isolated CABG treated with pexelizumab compared with control patients. 4 In the current article, the authors continue their series of studies of patients who are part of the same trial of the complement-binding protein in cardiac surgery in which cardiopulmonary bypass is used. The current study clearly demonstrates a benefit of pexelizumab in reducing both 30-day (3.8% vs 9.9%) and 180-day (5.7% vs 14.4%) mortality in this select, and presumably high-risk, group of patients.
Complement evolved to fight bacterial and
J. Thorac. Cardiovasc. Surg. 2006 131: 352-356.
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