Fuchs S, Kornowski R, Mehran R, Gruberg L, Satler L F, Pichard A D, Kent K M, Stone G W, Leon M B
The Cardiac Catheterization Laboratory, Washington Hospital Center, 110 Irving Street, N.W., Suite 4B-1, Washington, DC 20010, USA.
J Invasive Cardiol. 2000 Oct;12(10):497-501.
Pre-intervention administration of abciximab in patients at "high risk" for coronary angioplasty has been shown to reduce acute and long-term cardiac outcomes. The role of intra-procedural ("rescue") administration of abciximab has not been fully elucidated. We assessed the clinical outcomes associated with rescue administration of abciximab during complex percutaneous coronary interventions. We studied in-hospital and long-term (1-year) outcomes (death, myocardial infarction and target lesion revascularization) of 298 consecutive patients (78% male; age, 62 +/- 11 years; 83% with acute coronary syndrome) treated with abciximab for thrombus-containing lesions, sub-optimal angioplasty results, procedural dissections or other complications. Stents were used in 73% of procedures. Procedural success was 97.0% and overall major in-hospital complication rate was 3.0% (death, 1.3%; Q-wave myocardial infarction, 0.7%; and emergent bypass surgery, 1.0%). Most frequent angiographic complications included visible thrombus (17%), dissections (17%), threatened closure (7%), and distal embolization (7%). In-hospital non-Q wave myocardial infarction (defined as CK-MB 5 times normal) occurred in 31.0%. Out-of-hospital to one-year events included death (1.7%), Q-wave myocardial infarction (2.7%), and target lesion revascularization (15.1%); cardiac event-free survival was 82.9%. We conclude that rescue administration of abciximab is associated with relatively low in-hospital complications and favorable long-term outcome in patients with sub-optimal angioplasty results and/or procedure-related complications, although peri-procedural non-Q wave myocardial infarction rate is high. A clinical and cost-effective comparison between provisional and rescue administration of abciximab may be warranted.
对于冠状动脉血管成形术“高危”患者，术前给予阿昔单抗已被证明可改善急性和长期心脏预后。术中（“补救性”）给予阿昔单抗的作用尚未完全阐明。我们评估了在复杂经皮冠状动脉介入治疗期间补救性给予阿昔单抗的临床预后。我们研究了连续298例患者（78%为男性；年龄62±11岁；83%患有急性冠状动脉综合征）的住院和长期（1年）预后（死亡、心肌梗死和靶病变血运重建），这些患者因含血栓病变、血管成形术效果欠佳、手术夹层或其他并发症接受阿昔单抗治疗。73%的手术使用了支架。手术成功率为97.0%，总体住院主要并发症发生率为3.0%（死亡1.3%；Q波心肌梗死0.7%；急诊搭桥手术1.0%）。最常见的血管造影并发症包括可见血栓（17%）、夹层（17%）、濒临闭塞（7%）和远端栓塞（7%）。住院期间非Q波心肌梗死（定义为肌酸激酶同工酶超过正常上限5倍）发生率为31.0%。院外至1年的事件包括死亡（1.7%）、Q波心肌梗死（2.7%）和靶病变血运重建（15.1%）；无心脏事件生存率为82.9%。我们得出结论，尽管围手术期非Q波心肌梗死发生率较高，但对于血管成形术效果欠佳和/或与手术相关并发症的患者，补救性给予阿昔单抗与相对较低的住院并发症和良好的长期预后相关。阿昔单抗临时给药和补救性给药之间进行临床和成本效益比较可能是必要的。
