Karha Juhana, Gurm Hitinder S, Rajagopal Vivek, Fathi Robert, Bavry Anthony A, Brener Sorin J, Lincoff A Michael, Ellis Stephen G, Bhatt Deepak L
The Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Am J Cardiol. 2006 Oct 1;98(7):906-10. doi: 10.1016/j.amjcard.2006.04.037. Epub 2006 Aug 17.
Platelet glycoprotein (GP) IIb/IIIa inhibitors are widely used in percutaneous coronary intervention (PCI). Previous studies have suggested that they do not offer benefit in saphenous vein graft PCI. Nonetheless, their use remains widespread during vein graft angioplasty. We retrospectively analyzed 1,537 patients who underwent saphenous vein graft PCI. Patients who received a GP IIb/IIIa inhibitor (n = 941) were compared with those who did not receive any GP IIb/IIIa inhibitor (n = 596). The primary end point was myonecrosis after PCI (creatine kinase-MB level >3 times the upper reference limit). The incidence of myonecrosis after PCI was similar between the group that received GP IIb/IIIa and the group that did not (odds ratio for GP IIb/IIIa use 1.39, 95% confidence interval 0.97 to 2.00, p = 0.07). Propensity-adjusted analysis demonstrated no significant difference in myonecrosis after PCI, in-hospital mortality, Q-wave myocardial infarction, or bleeding (blood transfusion, retroperitoneal bleed, or hematoma) between the 2 groups. In an analysis restricted to patients who were treated with an emboli protection device, GP IIb/IIIa use was not associated with decreased myonecrosis after PCI (this was also the case for patients who were not treated with an emboli protection device). Unadjusted survival (mean follow-up 5.5 +/- 0.1 years) was similar between the group that received GP IIb/IIIa and the group that did not (log-rank test, p = 0.89). There was no difference in survival after adjusting for the propensity to receive a GP IIb/IIIa inhibitor (adjusted odds ratio for GP IIb/IIIa use 0.92, 95% confidence interval 0.69 to 1.23, p = 0.59). In conclusion, adjunctive use of platelet GP IIb/IIIa inhibitors in saphenous vein graft PCI does not appear to be associated with less myonecrosis or improved survival.
血小板糖蛋白（GP）IIb/IIIa抑制剂广泛应用于经皮冠状动脉介入治疗（PCI）。以往研究表明，它们在隐静脉移植血管PCI中并无益处。尽管如此，在静脉移植血管血管成形术中其使用仍很普遍。我们回顾性分析了1537例行隐静脉移植血管PCI的患者。将接受GP IIb/IIIa抑制剂治疗的患者（n = 941）与未接受任何GP IIb/IIIa抑制剂治疗的患者（n = 596）进行比较。主要终点为PCI术后心肌坏死（肌酸激酶-MB水平>正常上限3倍）。接受GP IIb/IIIa抑制剂治疗组与未接受治疗组PCI术后心肌坏死发生率相似（使用GP IIb/IIIa抑制剂的比值比为1.39，95%置信区间为0.97至2.00，p = 0.07）。倾向调整分析显示，两组在PCI术后心肌坏死、住院死亡率、Q波心肌梗死或出血（输血、腹膜后出血或血肿）方面无显著差异。在一项仅限于接受栓子保护装置治疗患者的分析中，使用GP IIb/IIIa抑制剂与PCI术后心肌坏死减少无关（未接受栓子保护装置治疗的患者情况亦如此）。接受GP IIb/IIIa抑制剂治疗组与未接受治疗组的未调整生存率（平均随访5.5±0.1年）相似（对数秩检验，p = 0.89）。在对接受GP IIb/IIIa抑制剂治疗的倾向进行调整后，生存率无差异（使用GP IIb/IIIa抑制剂的调整后比值比为0.92，95%置信区间为从0.69至1.23，p = 0.59）。总之，在隐静脉移植血管PCI中辅助使用血小板GP IIb/IIIa抑制剂似乎与减少心肌坏死或改善生存率无关。
