Long Kirsten H, Ting Henry H, McMurtry Erin K, Lennon Ryan J, Wood Douglas L, Holmes David R, Raveendran Ganesh, Rihal Charanjit S
Department of Health Sciences Research, Division of Health Care Policy and Research, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Value Health. 2008 May-Jun;11(3):462-9. doi: 10.1111/j.1524-4733.2007.00257.x.
Although the efficacy of platelet glycoprotein IIb/IIIa inhibitors (GPIIb/IIIa) in reducing complication rates during percutaneous coronary intervention (PCI) is well established, comparative studies assessing currently approved agents as administered in current practice are limited. We studied the clinical and length of stay (LOS) outcomes of patients undergoing PCI who received either abciximab or eptifibatide.
All patients undergoing elective, urgent, or emergency PCI at Mayo Clinic Rochester between November 17, 2000 and August 31, 2004 who received either abciximab or eptifibatide were included. Clinical, angiographic, and follow-up data were prospectively recorded in the Mayo Clinic PCI Registry; administrative data recorded LOS. We used logistic and Cox proportional hazard models to estimate the risk of adverse events and generalized linear modeling to predict LOS. Propensity score and standard risk adjustments were used to account for baseline differences.
A total of 2123 PCI patients received eptifibatide and 951 received abciximab. The adjusted odds ratio for in-hospital death and myocardial infarction (MI) with eptifibatide was 0.80 (95% CI 0.56-1.14, P = 0.21) versus abciximab. Adjusted hazard ratios for death and MI and for death, MI, or target vessel revascularization during a median follow-up of 24.6 months were 0.84 (95% CI 0.68-1.02, P = 0.08) and 0.95 (95% CI 0.81-1.11, P = 0.53), respectively. Adjusted postprocedural LOS was similar at 3.4 days.
This large observational study found no evidence of a clinical or LOS advantage to physician choice of either abciximab or eptifibatide during PCI in contemporary practice.
尽管血小板糖蛋白IIb/IIIa抑制剂（GPIIb/IIIa）在经皮冠状动脉介入治疗（PCI）期间降低并发症发生率方面的疗效已得到充分证实，但评估当前获批药物在当前临床实践中应用情况的比较研究却很有限。我们研究了接受阿昔单抗或依替巴肽的PCI患者的临床结局和住院时间（LOS）。
纳入2000年11月17日至2004年8月31日在罗切斯特梅奥诊所接受择期、紧急或急诊PCI且接受阿昔单抗或依替巴肽的所有患者。临床、血管造影和随访数据前瞻性记录于梅奥诊所PCI登记处；行政数据记录住院时间。我们使用逻辑回归和Cox比例风险模型估计不良事件风险，并使用广义线性模型预测住院时间。倾向评分和标准风险调整用于考虑基线差异。
共有2123例PCI患者接受依替巴肽，951例接受阿昔单抗。与阿昔单抗相比，依替巴肽治疗的院内死亡和心肌梗死（MI）调整后的优势比为0.80（95%CI 0.56-1.14，P = 0.21）。在中位随访24.6个月期间，死亡和MI以及死亡、MI或靶血管血运重建的调整后风险比分别为0.84（95%CI 0.68-1.02，P = 0.08）和0.95（95%CI 0.81-1.11，P = 0.53）。调整后的术后住院时间相似，为3.4天。
这项大型观察性研究发现，在当代临床实践中，医生选择阿昔单抗或依替巴肽进行PCI治疗时，在临床或住院时间方面均无优势。
