Taglieri Nevio, Saia Francesco, Guiducci Vincenzo, Tondi Stefano, Conrotto Federico, Marrozzini Cinzia, Rocchi Guido, Biagini Elena, Reggiani Maria Letizia Bacchi, Giacometti Paola, Piovaccari Giancarlo, Manari Antonio, Marzocchi Antonio
Istituto di Cardiologia, Università di Bologna, Policlinico S Orsola-Malpighi, Bologna, Italy.
Am J Cardiol. 2009 Mar 15;103(6):785-90. doi: 10.1016/j.amjcard.2008.11.029. Epub 2009 Jan 21.
Abciximab therapy during primary percutaneous coronary intervention (PCI) has shown to ameliorate left ventricular (LV) function recovery in patients with ST elevated myocardial infarction. High-dose bolus tirofiban has similar effect on platelet inhibition. Whether this is associated with comparable efficacy on LV function recovery remains unclear. We sought to evaluate the impact on LV function of high-dose bolus tirofiban or abciximab in patients undergoing primary PCI with the predictors of favorable (> or = 50%) LV ejection fraction (EF) and LV function recovery at 30 days. We studied 314 patients (abciximab n = 154; tirofiban n = 160) undergoing primary PCI in the randomized Facilitated Angioplasty with Tirofiban or Abciximab (FATA) Trial. LVEF was assessed within 48 hours and at 30 days after primary PCI. In patients with systolic dysfunction at baseline, LV function recovery was defined by either increase of LVEF > or = 10% compared with baseline or LVEF > or = 50%. Similar LVEF was observed in the 2 groups postprocedure (abciximab 49.7 +/- 10.1% vs tirofiban 49.3 +/- 10.1%, p = 0.9) and at 30 days (abciximab 53.1 +/- 9.8% vs tirofiban 52.5 +/- 10.2%, p = 0.6). Independent predictors of 30-day LVEF > or = 50% were preprocedure Thrombolysis In Myocardial Infarction flow class >0 (odds ratio = 2.4, 95% confidence interval 1.32 to 4.34), anterior location (odds ratio = 0.25, 95% confidence interval 0.15 to 0.42), and age (odds ratio = 0.97, 95% confidence interval 0.95 to 0.99). Preprocedure Thrombolysis In Myocardial Infarction flow grade >0 was the only predictor of LV function recovery (odds ratio = 6.73, 95% confidence interval 2.69 to 16.88). In conclusion, this study showed no difference in LV function recovery in patients undergoing primary PCI treated either with abciximab or high-dose bolus tirofiban. Preprocedure Thrombolysis In Myocardial Infarction flow grade >0 seems to be the most important predictor of favorable LVEF and LV function recovery at 30 days.
在直接经皮冠状动脉介入治疗（PCI）期间使用阿昔单抗已证明可改善ST段抬高型心肌梗死患者的左心室（LV）功能恢复。大剂量推注替罗非班对血小板抑制有类似作用。这是否与LV功能恢复的疗效相当尚不清楚。我们试图评估大剂量推注替罗非班或阿昔单抗对接受直接PCI患者LV功能的影响，这些患者具有30天时左心室射血分数（EF）有利（≥50%）和LV功能恢复的预测指标。我们在替罗非班或阿昔单抗促进血管成形术随机试验（FATA）中研究了314例接受直接PCI的患者（阿昔单抗组n = 154；替罗非班组n = 160）。在直接PCI后48小时内和30天时评估左心室射血分数。在基线存在收缩功能障碍的患者中，LV功能恢复的定义为与基线相比左心室射血分数增加≥10%或左心室射血分数≥50%。两组术后（阿昔单抗组49.7±10.1% vs替罗非班组49.3±10.1%，p = 0.9）和30天时（阿昔单抗组53.1±9.8% vs替罗非班组52.5±10.2%，p = 0.6）观察到相似的左心室射血分数。30天时左心室射血分数≥50%的独立预测因素为术前心肌梗死溶栓血流分级>0（比值比 = 2.4，95%置信区间1.32至4.34）、前壁部位（比值比 = 0.25，95%置信区间0.15至0.42）和年龄（比值比 = 0.97，95%置信区间0.95至0.99）。术前心肌梗死溶栓血流分级>0是LV功能恢复的唯一预测因素（比值比 = 6.73，95%置信区间2.69至16.88）。总之，本研究表明，接受直接PCI治疗的患者使用阿昔单抗或大剂量推注替罗非班后LV功能恢复无差异。术前心肌梗死溶栓血流分级>0似乎是30天时左心室射血分数良好和LV功能恢复的最重要预测因素。
Zotero 插件