Kini Annapoorna S, Chen Victor H T, Krishnan Prakash, Lee Paul, Kim Michael C, Mares Angelica, Suleman Javed, Moreno Pedro R, Sharma Samin K
Cardiac Catheterization Laboratory, Cardiovascular Institute, Mount Sinai Medical Center, New York, NY 10029-6574, USA.
Am Heart J. 2008 Sep;156(3):513-9. doi: 10.1016/j.ahj.2008.04.019. Epub 2008 Jul 2.
The present study was done to analyze if glycoprotein IIb/IIIa inhibitors (GPI) bolus-only will reduce vascular/bleeding complications and cost with similar major adverse cardiac events (MACE) when compared with GPI bolus + infusion. Evidence-based therapy of GPI inhibitors during percutaneous coronary intervention (PCI) incorporates intravenous bolus followed by 12 to 18 hours of infusion. However, GPI bolus + infusion may increase vascular/bleeding complications and may not reduce MACE when compared with GPI bolus-only.
From January 1, 2003, to December 31, 2004, 2,629 consecutive patients received GPI during PCI at a single center. Of these, 1,064 patients received GPI bolus + infusion in 2003 and were compared with 1,565 patients that received GPI bolus-only in 2004. Baseline characteristics were similar in both groups.
Patients receiving GPI bolus-only had reduced vascular/bleeding complications when compared with bolus + infusion (4.9% vs 7%, P < .05, odds ratio 0.62, 95% confidence interval 0.45-0.89). Furthermore, ischemic complications were similar in both groups, including periprocedural creatine kinase-MB enzyme release (12.8% vs 15.3%, P = NS), MACE at 30 days (3.2% vs 3%, P = NS), and death and myocardial infarction at 1 year (7.1% vs 7.8%, P = NS). In addition, GPI bolus-only reduced cost in US dollars ($323 vs $706, P < .001) and increased ambulatory PCI (13.1% vs 3.2%, P < .01), with reduced length of stay (1.1 vs 1.6 days, P < .01), when compared with GPI bolus + infusion.
Glycoprotein inhibitor bolus-only reduces vascular/bleeding complications with similar MACE and reduced cost when compared with GPI bolus + infusion. In addition, GPI bolus-only improved ambulatory PCI and reduced length of stay. These results are consistent with a safer and cost-effective strategy for bolus-only when GPI therapy is considered during PCI.
本研究旨在分析仅使用糖蛋白IIb/IIIa抑制剂（GPI）推注与GPI推注+输注相比，是否会减少血管/出血并发症并降低成本，同时具有相似的主要不良心脏事件（MACE）。经皮冠状动脉介入治疗（PCI）期间GPI抑制剂的循证治疗包括静脉推注，随后输注12至18小时。然而，与仅使用GPI推注相比，GPI推注+输注可能会增加血管/出血并发症，且可能不会降低MACE。
从2003年1月1日至2004年12月31日，在单一中心，2629例连续患者在PCI期间接受了GPI治疗。其中，2003年有1064例患者接受了GPI推注+输注，并与2004年接受仅GPI推注的1565例患者进行比较。两组的基线特征相似。
与推注+输注相比，仅接受GPI推注的患者血管/出血并发症减少（4.9%对7%，P<.05，优势比0.62，95%置信区间0.45-0.89）。此外，两组的缺血并发症相似，包括围手术期肌酸激酶-MB酶释放（12.8%对15.3%，P=无显著性差异）、30天时的MACE（3.2%对3%，P=无显著性差异）以及1年时的死亡和心肌梗死（7.1%对7.8%，P=无显著性差异）。此外，与GPI推注+输注相比，仅GPI推注降低了成本（323美元对706美元，P<.001），增加了门诊PCI（13.1%对3.2%，P<.01），缩短了住院时间（1.1天对1.6天，P<.01）。
与GPI推注+输注相比，仅使用GPI推注可减少血管/出血并发症，具有相似的MACE且成本降低。此外，仅GPI推注改善了门诊PCI并缩短了住院时间。这些结果与PCI期间考虑GPI治疗时仅推注的更安全且具成本效益的策略一致。
