糖尿病患者急性ST段抬高型心肌梗死接受纤溶或联合降低纤溶治疗及血小板糖蛋白IIb/IIIa抑制治疗的结果：来自GUSTO V试验的经验教训

Outcome of acute ST-segment elevation myocardial infarction in diabetics treated with fibrinolytic or combination reduced fibrinolytic therapy and platelet glycoprotein IIb/IIIa inhibition: lessons from the GUSTO V trial.

作者信息

Gurm Hitinder S, Lincoff A Michael, Lee David, Tang W H Wilson, Jia Gang, Booth Joan E, Califf Robert M, Ohman E M, Van de Werf Frans, Armstrong Paul W, Guetta Victor, Wilcox Robert, Topol Eric J

机构信息

Cleveland Clinic Foundation, Cleveland, Ohio, USA.

出版信息

J Am Coll Cardiol. 2004 Feb 18;43(4):542-8. doi: 10.1016/j.jacc.2003.09.038.

DOI:10.1016/j.jacc.2003.09.038

PMID:14975461

Abstract

OBJECTIVES

We studied the outcome of diabetics enrolled in the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) V trial to assess whether the combination of half-dose reteplase and abciximab provides any propitious benefits over standard fibrinolytic therapy in diabetic patients.

BACKGROUND

Diabetics with acute ST-segment elevation myocardial infarction (MI) have a worse outcome compared with nondiabetics. Higher-risk patients are usually more likely to benefit from advances in medical therapy.

METHODS

We analyzed diabetic patients enrolled in the GUSTO V trial to assess the outcome of those randomized to the combination of half-dose reteplase and abciximab versus those randomized to reteplase. We also evaluated whether any differences existed in presentation and outcome of MI among the diabetics versus the nondiabetics enrolled in the study.

RESULTS

The trial enrolled 13782 nondiabetics and 2633 diabetics. Compared to nondiabetics, diabetics had a significantly higher mortality at 30 days (8.5% vs. 5.1%, p < 0.001) and at 1 year (12.7% vs. 7.5%, p < 0.001). Among the diabetic subset, no significant difference existed in the incidence of 30-day (8.8% vs. 8.2%, p = 0.52) or 1-year mortality (13.0% vs. 12.4%, p = 0.62) among patients randomized to reteplase compared to those receiving combination of abciximab and reteplase. The incidence of reinfarction (2.5% vs. 4.3%, p = 0.013), recurrent ischemia (11.8% vs. 14.9%, p = 0.017), and urgent revascularization (10.9% vs. 13.3%, p = 0.055) at seven days was lower in diabetics treated with the combination therapy.

CONCLUSIONS

Compared to nondiabetics, diabetics continue to have a worse outcome with MI. Although combination therapy did not provide a survival benefit, nonfatal ischemic outcomes, including reinfarction, recurrent ischemia, and urgent revascularization, were substantially reduced.

摘要

目的

我们研究了纳入全球应用开放闭塞冠状动脉策略（GUSTO）V试验的糖尿病患者的预后情况，以评估半量瑞替普酶与阿昔单抗联合用药相较于标准溶栓治疗，能否为糖尿病患者带来任何有利益处。

背景

与非糖尿病患者相比，急性ST段抬高型心肌梗死（MI）的糖尿病患者预后更差。高风险患者通常更有可能从医学治疗进展中获益。

方法

我们分析了纳入GUSTO V试验的糖尿病患者，以评估随机接受半量瑞替普酶与阿昔单抗联合用药的患者与随机接受瑞替普酶治疗的患者的预后情况。我们还评估了该研究中糖尿病患者与非糖尿病患者在MI的表现和预后方面是否存在差异。

结果

该试验纳入了13782名非糖尿病患者和2633名糖尿病患者。与非糖尿病患者相比，糖尿病患者在30天时的死亡率显著更高（8.5%对5.1%，p<0.001），在1年时也是如此（12.7%对7.5%，p<0.001）。在糖尿病亚组中，随机接受瑞替普酶治疗的患者与接受阿昔单抗和瑞替普酶联合治疗的患者相比，30天（8.8%对8.2%，p = 0.52）或1年死亡率（13.0%对12.4%，p = 0.62）的发生率没有显著差异。联合治疗的糖尿病患者在7天时的再梗死发生率（2.5%对4.3%，p = 0.013）、复发性缺血发生率（11.8%对14.9%，p = 0.017）和紧急血管重建发生率（10.9%对13.3%，p = 0.055）更低。