[TCT2007]直接PCI术中联用阿昔单抗减少不良事件发生

发布于:2007-10-24 14:55

　　应用瑞替普酶/阿昔单抗易化PCI和阿昔单抗易化PCI不良事件常见。

Fewer Adverse Events With In-lab Abciximab for PCI

　　根据FINESS试验的结果，直接PCI术中给予阿昔单抗与患者的获得最好的危险/效益比相关。

　　来自克利夫兰FINESSE临床和研究者Stephen Ellis医生说：直接PCI在导管室给予阿昔单抗优于其他两种治疗方法的分析：药物易化后进行PCI治疗即应用阿昔单抗易化PCI和阿昔单抗加半量瑞替普酶易化PCI。

　　Ellis说：“直接PCI在导管室中应用阿昔单抗与其他两种治疗方法相比，主要终点没有明显的改善。”

　　主要终点是90天复合终点包括全因死亡，再住院或因心力衰竭急诊治疗，随机后超过48小时发生的因室颤进行的复苏或者心源性休克。

　　在导管室注射阿昔单抗在整个住院期间或者治疗后第7天，主要和次要出血事件、TIMI血流优于瑞替普酶/阿昔单抗易化和单独阿昔单抗易化。

　　瑞替普酶/阿昔单抗早期给予与增加介入治疗前TIMI血流有关，有超过70％的患者在注射后60－90分钟ST段回落，三种治疗策略在PCI后TIMI3级血流和ST段回落时间上（180－240分钟）没有差别。

　　FINESS试验分析了来自20个国家2452例STEMI患者，所有的患者在出现症状6小时内到达医院。Ellis医生说道：该研究仅入选了原计划患者数的82％，但即使更大样本量的研究得到的结果也不会有差别。他说，PCI之前药物联合治疗可能有益，尤其在比较常见的因患者转运而耽误了时间的情况下。这与增加患者的死亡率相关。PCI之前越早期再灌注越有利于挽救心肌并可获得更好的长期结果。

　　（阜外心血管病医院　高立建　编译）

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Fewer Adverse Events With In-lab Abciximab for PCI

Adverse events more common with reteplase/abciximab-facilitated PCI and abciximab-facilitated PCI.

In-lab administration of abciximab is associated with the best risk-to-benefit profile in patients undergoing primary PCI, according to results of the FINESSE trial.

Stephen Ellis, MD, from The Cleveland Clinic and a researcher with FINESSE, said primary PCI with in-lab administration of abciximab (ReoPro, Centocor) was superior to the other two treatments analyzed: primary PCI facilitated with abciximab and primary PCI facilitated with abciximab plus half-dose reteplase (Retavase, Centocor).

“No significant improvement in the primary endpoint or components was observed with either reteplase/abciximab-facilitated PCI or abciximab-facilitated PCI compared with primary PCI with in-lab administration of abciximab,” Ellis said.

The primary endpoint was a composite at 90 days of all-cause mortality, rehospitalization or emergency department treatment for CHF, resuscitated ventricular fibrillation more than 48 hours after randomization, or cardiogenic shock.

In-lab administration of abciximab was superior to reteplase/abciximab facilitation and abciximab facilitation alone in terms of TIMI major or minor bleeding through discharge or day 7 (Figure).

Reteplase/abciximab administered early was associated with an increase in pre-PCI TIMI-3 flow and more than 70% ST-segment resolution at 60 to 90 minutes. Post-PCI TIMI-3 flow and ST resolution at 180 to 240 minutes were similar among all three strategies.

Ellis said that although the study enrolled only 82% of the planned number of patients, it is unlikely that different results would have been seen with a larger cohort.

He said that pharmacotherapy prior to PCI may be beneficial, particularly because delays due to patient transfer are common. Such delays are associated with an increased risk of mortality. “Early pharmacologic reperfusion pre-PCI may lead to myocardial salvage and better long-term outcomes,” Ellis said.

FINESSE analyzed 2,452 patients with STEMI from 20 countries. All patients presented within 6 hours of the onset of symptoms.

“Early pharmacologic reperfusion pre-PCI may lead to myocardial salvage and better long-term outcomes.”
— Stephen Ellis, MD

来源：医心网

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