Ross Mitchell J, Herrmann Howard C, Moliterno David J, Blankenship James C, Demopoulos Laura, DiBattiste Peter M, Ellis Stephen G, Ghazzal Ziyad, Martin Jack L, White Jennifer, Topol Eric J
Division of Cardiology, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA.
J Am Coll Cardiol. 2003 Sep 17;42(6):981-8. doi: 10.1016/s0735-1097(03)00913-6.
We sought to assess whether pre-procedural angiographic characteristics are associated with adverse clinical outcomes after coronary stenting with glycoprotein IIb/IIIa inhibition.
Ischemic complications after balloon angioplasty are associated with pre- and post-procedural angiographic variables. However, in the current era of stenting with IIb/IIIa inhibition, it is unknown whether angiographic features assessed before intervention confer an increased risk of adverse procedural and subsequent clinical outcomes.
In the Do Tirofiban and ReoPro Give Similar Efficacy Outcomes? Trial (TARGET), 4,809 patients undergoing planned stenting were randomized to tirofiban or abciximab. Baseline demographic, clinical, and angiographic variables were obtained. Clinical end points were recorded at 30 days and six months. The relationship between angiographic variables and adverse clinical outcomes was assessed.
Patients with the combination of thrombus, lesion eccentricity, and lesion length >20 mm had a 21.4% composite incidence of death, myocardial infarction, or urgent target vessel revascularization (TVR) at 30 days, compared with 4.2% in those patients without these high-risk features (hazard ratio [HR] 3.24, p < 0.001). After adjustment, the risk was independently associated with thrombus (HR 1.40, p = 0.034), eccentricity (HR 1.67, p < 0.001), and lesion length >20 mm (HR 1.89, p < 0.001). The risk of six-month TVR was independently associated with left anterior descending coronary artery lesions (HR 1.46, p < 0.001), restenotic lesions at baseline (HR 1.58, p = 0.006), and lesion length (HR 1.19, p = 0.03).
Patients with thrombus, eccentric lesions, or lesion length >20 mm are at high risk for ischemic outcomes after coronary stenting, despite IIb/IIIa inhibition. Further research into novel anti-thrombotic therapies or procedural strategies is necessary for these patients.
我们试图评估冠状动脉支架置入术中使用糖蛋白IIb/IIIa抑制剂之前的血管造影特征是否与不良临床结局相关。
球囊血管成形术后的缺血性并发症与术前和术后血管造影变量有关。然而，在当前使用IIb/IIIa抑制剂进行支架置入的时代，干预前评估的血管造影特征是否会增加不良手术及后续临床结局的风险尚不清楚。
在替罗非班与阿昔单抗疗效相似吗？试验（TARGET）中，4809例计划进行支架置入的患者被随机分为替罗非班组或阿昔单抗组。获取基线人口统计学、临床和血管造影变量。在30天和6个月时记录临床终点。评估血管造影变量与不良临床结局之间的关系。
有血栓、病变偏心和病变长度>20 mm的患者在30天时死亡、心肌梗死或紧急靶血管血运重建（TVR）的复合发生率为21.4%，而无这些高危特征的患者为4.2%（风险比[HR] 3.24，p<0.001）。调整后，风险与血栓（HR 1.40，p = 0.034）、偏心（HR 1.67，p<0.001）和病变长度>20 mm（HR 1.89，p<0.001）独立相关。6个月时TVR的风险与左前降支冠状动脉病变（HR 1.46，p<0.001）、基线再狭窄病变（HR 1.58，p = 0.006）和病变长度（HR 1.19，p = 0.03）独立相关。
尽管使用了IIb/IIIa抑制剂，但有血栓、偏心病变或病变长度>20 mm的患者在冠状动脉支架置入术后发生缺血性结局的风险较高。对于这些患者，有必要进一步研究新型抗血栓治疗或手术策略。
