Young John J, Kereiakes Dean J
The Carl and Edyth Lindner Center for Research and Education, Cincinnati, OH 45219, USA.
J Invasive Cardiol. 2002 Jul;14(7):404-10.
Over the past decade, numerous placebo-controlled randomized clinical trials have documented robust clinical benefits of intravenous platelet glycoprotein (GP) IIb/IIIa inhibitors in patients undergoing percutaneous coronary intervention (PCI). This evidence has led to U.S. Food and Drug Administration approval and indication for use of two GP IIb/IIIa inhibitors at the time of PCI, namely, the chimeric monoclonal antibody fragment abciximab (ReoPro, Centocor, Inc. and Eli Lilly & Company) and the cyclic heptapeptide small molecule eptifibatide (Integrilin, COR Therapeutics and Key Pharmaceuticals). Currently, another small molecule GP IIb/IIIa inhibitor, tirofiban (Aggrastat, Merck & Company), which (similar to eptifibatide) is approved for the medical therapy of patients with non-ST segment elevation acute coronary syndromes (ACS), has not received indication for use in the PCI setting. Although the clinical benefits of both abciximab and eptifibatide administered at the time of PCI have been proven in randomized clinical trials, only abciximab has demonstrated a late survival advantage in patients following PCI. Evidence in support of the presence, magnitude and possible mechanisms for abciximab survival advantage is herein reviewed.
在过去十年中，大量安慰剂对照随机临床试验证明，静脉注射血小板糖蛋白（GP）IIb/IIIa抑制剂对接受经皮冠状动脉介入治疗（PCI）的患者具有显著的临床益处。这一证据促使美国食品药品监督管理局批准并指明在PCI时使用两种GP IIb/IIIa抑制剂，即嵌合单克隆抗体片段阿昔单抗（ReoPro，Centocor公司和礼来公司）和环庚肽小分子依替巴肽（Integrilin，COR Therapeutics公司和Key Pharmaceuticals公司）。目前，另一种小分子GP IIb/IIIa抑制剂替罗非班（Aggrastat，默克公司），（与依替巴肽类似）已被批准用于非ST段抬高急性冠状动脉综合征（ACS）患者的药物治疗，但尚未获得在PCI环境中使用的指征。尽管在随机临床试验中已证明PCI时使用阿昔单抗和依替巴肽均具有临床益处，但只有阿昔单抗在PCI后患者中显示出晚期生存优势。本文综述了支持阿昔单抗生存优势的存在、程度及可能机制的证据。
