Tornvall P, Nilsson T, Lagerqvist B
Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
J Intern Med. 2006 Oct;260(4):363-8. doi: 10.1111/j.1365-2796.2006.01696.x.
To investigate the effects of abciximab on mortality in ST-elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI) including stent implantation.
Meta-analysis of three selected randomized studies and analysis of data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR).
Pooled data from randomized studies containing in total 1,736 patients undergoing PCI with stent implantation because of STEMI with duration between symptom and treatment <12 h, and 7,436 patients from SCAAR treated with PCI because of STEMI (52% treated with abciximab) in Sweden 2000-2004.
Analyses of pooled data showed that abciximab was associated with a decreased risk of reinfarction [odds ratio (OR) 0.38] and urgent target vessel revascularization (OR 0.38) at 30 days. No effect was seen on mortality at 30 days or 6 months. Multivariate analysis of data from SCAAR showed that abciximab reduced the risk of death during 14 months of follow-up (hazard ratio 0.82).
The results are encouraging and support the ACC/AHA and ESC recommendation to use abciximab in treatment of STEMI with PCI including stent implantation. Considering that the pooled results from previous trials showed no effect of abciximab on mortality and the registry part of the present study was observational, the results encourage carrying out new randomized studies of abciximab in STEMI treated with PCI, including stent implantation, with sufficient size and length of follow-up.
探讨阿昔单抗对接受经皮冠状动脉介入治疗（PCI）包括支架植入术的ST段抬高型心肌梗死（STEMI）患者死亡率的影响。
对三项选定的随机研究进行荟萃分析，并对瑞典冠状动脉造影和血管成形术登记处（SCAAR）的数据进行分析。
随机研究的汇总数据，总共包括1736例因STEMI且症状出现至治疗时间<12小时而接受PCI及支架植入术的患者，以及2000 - 2004年在瑞典因STEMI接受PCI治疗的7436例SCAAR患者（52%接受阿昔单抗治疗）。
汇总数据分析显示，阿昔单抗与30天时再梗死风险降低[比值比（OR）0.38]和紧急靶血管血运重建风险降低（OR 0.38）相关。在30天或6个月时未观察到对死亡率的影响。对SCAAR数据的多变量分析显示，阿昔单抗降低了14个月随访期间的死亡风险（风险比0.82）。
结果令人鼓舞，支持美国心脏病学会/美国心脏协会（ACC/AHA）和欧洲心脏病学会（ESC）关于在包括支架植入术的PCI治疗STEMI中使用阿昔单抗的建议。鉴于先前试验的汇总结果显示阿昔单抗对死亡率无影响，且本研究的登记部分为观察性研究，这些结果鼓励开展新的关于阿昔单抗在包括支架植入术的PCI治疗STEMI中的随机研究，要有足够的样本量和随访时长。
