Brown D L, Fann C S, Chang C J
Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx New York 10461, USA.
Am J Cardiol. 2001 Mar 1;87(5):537-41. doi: 10.1016/s0002-9149(00)01427-2.
Three platelet glycoprotein (GP) IIb/IIIa receptor antagonists have been evaluated in patients undergoing percutaneous coronary intervention (PCI). One of these agents, abciximab, is structurally and pharmacologically quite different from the other 2, eptifibatide and tirofiban. We conducted a meta-analysis to determine whether different antagonist types achieved different clinical outcomes, possibly related to their structural differences. Odds ratios (OR) were calculated and a random effects model was used to combine the outcomes of 14,644 patients enrolled in 8 prospective, randomized, placebo-controlled clinical trials assessing treatment with a GP IIb/IIIa inhibitor to prevent ischemic complications of PCI. Neither abciximab (OR 0.69; 95% confidence interval [CI] 0.4 to 1.9) nor eptifibatide or tirofiban treatment (OR 0.74; 95% CI 0.4 to 1.28) resulted in reductions in mortality. Only the abciximab-treated patients had reductions in myocardial infarction (4.3% vs 8.5%, OR 0.49; 95% CI 0.40 to 0.59). There was no effect of eptifibatide or tirofiban on myocardial infarction (OR 0.85; 95% CI 0.69 to 1.04). Urgent revascularization was reduced in both abciximab-treated (2.7% vs 6.2%, OR 0.42; 95% CI 0.34 to 0.53) and eptifibatide- and tirofiban-treated (4.2% vs 5.5%, OR 0.76; 95% CI 0.60 to 0.96) groups. Only abciximab-treated patients had increased major bleeding (5.8% vs 3.8%; OR 1.53; 95% CI 1.24 to 1.90). There was no effect of eptifibatide or tirofiban on major bleeding (5.0% vs 4.3%; OR 1.19; 95% CI 0.94 to 1.52). Thus, significant differences exist between clinical outcomes achieved by abciximab and those achieved by eptifibatide or tirofiban following PCl procedures.
三种血小板糖蛋白（GP）IIb/IIIa受体拮抗剂已在接受经皮冠状动脉介入治疗（PCI）的患者中进行了评估。其中一种药物阿昔单抗，在结构和药理上与另外两种药物依替巴肽和替罗非班有很大不同。我们进行了一项荟萃分析，以确定不同类型的拮抗剂是否能实现不同的临床结果，这可能与其结构差异有关。计算了比值比（OR），并使用随机效应模型汇总了14,644例患者的结果，这些患者参与了8项前瞻性、随机、安慰剂对照的临床试验，评估使用GP IIb/IIIa抑制剂预防PCI缺血性并发症的治疗效果。阿昔单抗治疗组（OR 0.69；95%置信区间[CI] 0.4至1.9）以及依替巴肽或替罗非班治疗组（OR 0.74；95% CI 0.4至1.28）均未降低死亡率。只有接受阿昔单抗治疗的患者心肌梗死发生率降低（4.3%对8.5%，OR 0.49；95% CI 0.40至0.59）。依替巴肽或替罗非班对心肌梗死无影响（OR 0.85；95% CI 0.69至1.04）。阿昔单抗治疗组（2.7%对6.2%，OR 0.42；95% CI 0.34至0.53）以及依替巴肽和替罗非班治疗组（4.2%对5.5%，OR 0.76；95% CI 0.60至0.96）的紧急血运重建率均降低。只有接受阿昔单抗治疗的患者严重出血增加（5.8%对3.8%；OR 1.53；95% CI 1.24至1.90）。依替巴肽或替罗非班对严重出血无影响（5.0%对4.3%；OR 1.19；95% CI 0.94至1.52）。因此，PCI术后阿昔单抗所取得的临床结果与依替巴肽或替罗非班所取得的临床结果之间存在显著差异。
