与全剂量替奈普酶相比，小剂量替奈普酶联合依替巴肽可改善急性ST段抬高型心肌梗死患者ST段恢复的速度和稳定性。

Improved speed and stability of ST-segment recovery with reduced-dose tenecteplase and eptifibatide compared with full-dose tenecteplase for acute ST-segment elevation myocardial infarction.

作者信息

Roe Matthew T, Green Cynthia L, Giugliano Robert P, Gibson C Michael, Baran Kenneth, Greenberg Mark, Palmeri Sebastian T, Crater Suzanne, Trollinger Kathleen, Hannan Karen, Harrington Robert A, Krucoff Mitchell W

机构信息

Duke Clinical Research Institute and Division of Cardiology, Duke Medical Center, Durham, North Carolina 27715, USA.

出版信息

J Am Coll Cardiol. 2004 Feb 18;43(4):549-56. doi: 10.1016/j.jacc.2003.09.039.

DOI:10.1016/j.jacc.2003.09.039

PMID:14975462

Abstract

OBJECTIVES

This sub-study of the Integrilin and Tenecteplase in Acute Myocardial Infarction (INTEGRITI) trial evaluated of the impact of combination reperfusion therapy with reduced-dose tenecteplase plus eptifibatide on continuous ST-segment recovery and angiographic results.

BACKGROUND

Combination therapy with reduced-dose fibrinolytics and glycoprotein IIb/IIIa inhibitors for ST-segment elevation myocardial infarction improves biomarkers of reperfusion success but has not reduced mortality when compared with full-dose fibrinolytics.

METHODS

We evaluated 140 patients enrolled in the INTEGRITI trial with 24-h continuous 12-lead ST-segment monitoring and angiography at 60 min. The dose-combination regimen of 50% of standard-dose tenecteplase (0.27 microg/kg) plus high-dose eptifibatide (2 boluses of 180 microg/kg separated by 10 min, 2.0 microg/kg/min infusion) was compared with full-dose tenecteplase (0.53 microg/kg).

RESULTS

The dose-confirmation regimen of reduced-dose tenecteplase plus high-dose eptifibatide was associated with a faster median time to stable ST-segment recovery (55 vs. 98 min, p = 0.06), improved stable ST-segment recovery by 2 h (89.6% vs. 67.7%, p = 0.02), and less recurrent ischemia (34.0% vs. 57.1%, p = 0.05) when compared with full-dose tenecteplase. Continuously updated ST-segment recovery analyses demonstrated a modest trend toward greater ST-segment recovery at 30 min (57.7% vs. 40.6%, p = 0.13) and 60 min (82.7% vs. 65.6%, p = 0.08) with this regimen. These findings correlated with improved angiographic results at 60 min.

CONCLUSIONS

Combination therapy with reduced-dose tenecteplase and eptifibatide leads to faster, more stable ST-segment recovery and improved angiographic flow patterns, compared with full-dose tenecteplase. These findings question the relationship between biomarkers of reperfusion success and clinical outcomes.

摘要

目的

急性心肌梗死中依替巴肽与替奈普酶（INTEGRITI）试验的这项子研究评估了低剂量替奈普酶加依替巴肽联合再灌注治疗对ST段持续恢复及血管造影结果的影响。

背景

低剂量纤溶药物与糖蛋白IIb/IIIa抑制剂联合治疗ST段抬高型心肌梗死可改善再灌注成功的生物标志物，但与全剂量纤溶药物相比，并未降低死亡率。

方法

我们评估了INTEGRITI试验中140例患者，进行24小时连续12导联ST段监测并于60分钟时进行血管造影。将标准剂量替奈普酶50%（0.27微克/千克）加高剂量依替巴肽（180微克/千克的2次推注，间隔10分钟，输注速度2.0微克/千克/分钟）的剂量联合方案与全剂量替奈普酶（0.53微克/千克）进行比较。

结果

与全剂量替奈普酶相比，低剂量替奈普酶加高剂量依替巴肽的剂量确认方案与ST段恢复至稳定的中位时间更快相关（55分钟对98分钟，p = 0.06），2小时时稳定ST段恢复情况改善（89.6%对67.7%，p = 0.02），且再发缺血较少（34.0%对57.1%，p = 0.05）。持续更新的ST段恢复分析显示，该方案在30分钟（57.7%对40.6%，p = 0.13）和60分钟（82.7%对65.6%，p = 0.08）时有ST段恢复程度更高的适度趋势。这些发现与60分钟时改善的血管造影结果相关。