Servoss Stephen J, Wan Ying, Snapinn Steven M, DiBattiste Peter M, Zhao Xue-Qiao, Theroux Pierre, Jang Ik-Kyung, Januzzi James L
Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
Am J Cardiol. 2004 Apr 1;93(7):843-7. doi: 10.1016/j.amjcard.2003.12.021.
The role of glycoprotein IIb/IIIa platelet receptor antagonist therapy for patients with an acute coronary syndrome (ACS) and a history of coronary artery bypass grafting (CABG) remains incompletely defined. We examined the outcomes of patients with an ACS and prior CABG who were treated with tirofiban versus placebo among subjects with prior CABG in the Platelet Receptor Inhibition in Ischemic Syndrome Management in Patients Limited by Unstable Signs and Symptoms (PRISM-PLUS) trial. Of 1,570 patients treated with tirofiban plus heparin (n = 773) or heparin alone (n = 797), 231 had prior CABG. Compared with patients without prior CABG, those with prior CABG were more likely to have risk factors for a complicated ACS course, including severe coronary artery disease and heart failure (all p <0.0001), typically had clinical predictors of benefit from tirofiban, such as ST-segment depression (p = 0.01) or a TIMI risk score >or=4 (p <0.001), and were more likely to die or have a myocardial infarction or refractory ischemia at all time points examined (p <0.0001). Among patients with prior CABG, decreases in the incidence of death, myocardial infarction, or refractory ischemia with tirofiban and heparin versus heparin alone were noted at 7 and 30 days (7 days: 16.9% vs 29.0%, p = 0.035; 30 days: 25.0% vs 40.2%, p = 0.015). Trends toward a decrease in death, myocardial infarction, and refractory ischemia with tirofiban and heparin versus heparin alone in the prior CABG subgroup were noted at 48 hours and 180 days (48 hours: 6.5% vs 14.0%, p = 0.09; 180 days: 37.1% vs 48.6%, p = 0.057). Bleeding rates were similar in patients with and without prior CABG. Tirofiban was well tolerated and tended to decrease the considerable risk for ischemic ACS complications in patients with prior CABG.
糖蛋白IIb/IIIa血小板受体拮抗剂疗法对于患有急性冠状动脉综合征（ACS）且有冠状动脉旁路移植术（CABG）病史的患者的作用仍未完全明确。在“血小板受体抑制在不稳定体征和症状受限患者的缺血综合征管理中（PRISM-PLUS）”试验中，我们研究了患有ACS和既往CABG的患者接受替罗非班治疗与接受安慰剂治疗的结果，这些患者均有既往CABG史。在1570例接受替罗非班加肝素治疗（n = 773）或仅接受肝素治疗（n = 797）的患者中，231例有既往CABG史。与无既往CABG史患者相比，有既往CABG史患者更可能有ACS病程复杂的危险因素，包括严重冠状动脉疾病和心力衰竭（所有p<0.0001），通常有从替罗非班治疗中获益的临床预测因素，如ST段压低（p = 0.01）或TIMI风险评分≥4（p<0.001），并且在所有检查时间点更可能死亡、发生心肌梗死或出现难治性缺血（p<0.0001）。在有既往CABG史的患者中，与仅接受肝素治疗相比，替罗非班联合肝素治疗在7天和30天时死亡、心肌梗死或难治性缺血的发生率有所降低（7天：16.9%对29.0%，p = 0.035；30天：25.0%对40.2%，p = 0.015）。在既往CABG亚组中，在48小时和180天时，与仅接受肝素治疗相比，替罗非班联合肝素治疗在死亡、心肌梗死和难治性缺血方面有降低趋势（48小时：6.5%对14.0%，p = 0.09；180天：37.1%对48.6%，p = 0.057）。有和无既往CABG史患者的出血率相似。替罗非班耐受性良好，且倾向于降低有既往CABG史患者缺血性ACS并发症的显著风险。
