Best Patricia J M, Lennon Ryan, Gersh Bernard J, Ting Henry H, Rihal Charanjit S, Bell Malcolm R, Herzog Charles A, Holmes David R, Berger Peter B
Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minn 55905, USA.
Am Heart J. 2003 Aug;146(2):345-50. doi: 10.1016/S0002-8703(03)00231-X.
Patients with chronic renal insufficiency (CRI) have worse outcomes during and after percutaneous coronary interventions (PCI). Abciximab reduces complications, but may cause excessive bleeding in patients with CRI. Therefore, we sought to determine the safety of abciximab in patients with CRI.
Patients (n = 4158) undergoing PCI at the Mayo Clinic since abciximab became available were analyzed according to their estimated creatinine clearance (> or =70, 50-69, or <50 mL/min) or need for dialysis. Major bleeding was defined as a cerebrovascular bleed or a decrease in the hematocrit level >15%. Minor bleeding was defined as a decrease in the hematocrit level of 10% to 15% with an identifiable site of bleeding.
CRI was associated with increased bleeding in patients who received abciximab and patients who did not. However, there was only a trend toward an interaction between creatinine clearance and major bleeding with abciximab (odds ratio [OR], 1.18; P =.06) and no interaction with minor bleeding (OR, 1.01; P =.94) or any bleeding (OR, 1.10; P =.15).
CRI is associated with an increased risk of bleeding complications after PCI. Although abciximab increases the risk of bleeding in all patients, the increase in relative risk is not significantly greater in patients with CRI. Thus, abciximab may be given safely in patients with CRI who are undergoing PCI.
慢性肾功能不全（CRI）患者在经皮冠状动脉介入治疗（PCI）期间及之后的预后较差。阿昔单抗可减少并发症，但可能导致CRI患者出现过度出血。因此，我们试图确定阿昔单抗在CRI患者中的安全性。
对自阿昔单抗上市以来在梅奥诊所接受PCI的患者（n = 4158），根据其估算的肌酐清除率（≥70、50 - 69或<50 ml/min）或透析需求进行分析。大出血定义为脑血管出血或血细胞比容水平下降>15%。小出血定义为血细胞比容水平下降10%至15%且有可识别的出血部位。
CRI与接受阿昔单抗和未接受阿昔单抗的患者出血增加相关。然而，肌酐清除率与阿昔单抗所致大出血之间仅存在交互作用趋势（优势比[OR]，1.18；P = 0.06），与小出血无交互作用（OR，1.01；P = 0.94），与任何出血均无交互作用（OR，1.10；P = 0.15）。
CRI与PCI后出血并发症风险增加相关。虽然阿昔单抗会增加所有患者的出血风险，但CRI患者的相对风险增加幅度并不显著更大。因此，正在接受PCI的CRI患者可安全使用阿昔单抗。
