Teirstein Paul S, Kao John, Watkins Matthew, Tannenbaum Mark A, Laufer Nathan, Chang Michael, Mehran Roxana, Dangas George, Russell Mary E, Ellis Stephen G, Stone Gregg W
Scripps Clinic, La Jolla, California, USA.
Am J Cardiol. 2005 Aug 15;96(4):500-5. doi: 10.1016/j.amjcard.2005.04.009.
Whether the benefits that glycoprotein IIb/IIIa inhibitors confer in patients who undergo bare metal stent implantation extend to drug-eluting stents is unknown. We performed a prespecified subgroup analysis of the TAXUS IV study population to examine the effect of procedural glycoprotein IIb/IIIa inhibition during paclitaxel-eluting stent implantation on periprocedural creatine kinase-MB (CK-MB) levels. Glycoprotein (GP) IIb/IIIa inhibitors were administered to 57.7% of patients who had been randomized to receive the TAXUS stent and to 56.7% of those who had been randomized to receive the control stent. Among patients who received the TAXUS stent, the rate of CK-MB increases of >3 times the normal level was 2.6-fold higher in those who received a GP IIb/IIIa inhibitor than in those who did not (11.4% vs 4.4%, p = 0.0015). Composite rates of major adverse cardiac events and target vessel failure were also higher at 1 month in the GP IIb/IIIa group. By multivariate analysis, use of GP IIb/IIIa inhibitors during stenting with the TAXUS stent was an independent predictor of CK-MB increases >3 times the normal level. Further studies are warranted.
糖蛋白IIb/IIIa抑制剂对接受裸金属支架植入的患者有益，但其益处是否能扩展至药物洗脱支架尚不清楚。我们对TAXUS IV研究人群进行了一项预先设定的亚组分析，以研究在紫杉醇洗脱支架植入过程中进行程序性糖蛋白IIb/IIIa抑制对围手术期肌酸激酶MB（CK-MB）水平的影响。在随机接受TAXUS支架的患者中，57.7%使用了糖蛋白（GP）IIb/IIIa抑制剂；在随机接受对照支架的患者中，这一比例为56.7%。在接受TAXUS支架的患者中，接受GP IIb/IIIa抑制剂的患者CK-MB升高至正常水平3倍以上的发生率比未接受者高2.6倍（11.4%对4.4%，p = 0.0015）。GP IIb/IIIa组在1个月时主要不良心脏事件和靶血管失败的综合发生率也更高。通过多变量分析，在使用TAXUS支架进行支架植入过程中使用GP IIb/IIIa抑制剂是CK-MB升高至正常水平3倍以上的独立预测因素。有必要进行进一步研究。
