在接受直接经皮冠状动脉腔内血管成形术治疗的ST段抬高型心肌梗死患者中，与阿昔单抗相比，小分子药物给药的益处：一项荟萃分析。

Benefits from small molecule administration as compared with abciximab among patients with ST-segment elevation myocardial infarction treated with primary angioplasty: a meta-analysis.

作者信息

De Luca Giuseppe, Ucci Grazia, Cassetti Ettore, Marino Paolo

机构信息

Division of Cardiology, Maggiore della Carità Hospital, Eastern Piedmont University A. Avogadro, Novara, Italy.

出版信息

J Am Coll Cardiol. 2009 May 5;53(18):1668-73. doi: 10.1016/j.jacc.2009.01.053.

DOI:10.1016/j.jacc.2009.01.053

PMID:19406342

Abstract

OBJECTIVES

The aim of the study was to perform a meta-analysis of randomized trials (RTs) comparing abciximab versus small molecules (eptifibatide and tirofiban) in primary angioplasty (PPCI) for ST-segment elevation myocardial infarction (STEMI).

BACKGROUND

Abciximab has been shown to provide significant benefits in PPCI for STEMI. However, small molecules represent an attractive strategy due to the reversibility of the inhibition of platelet aggregation and the lower costs.

METHODS

We obtained results from RTs comparing abciximab versus small molecules in PPCI. The literature was scanned by searches of electronic databases (MEDLINE and CENTRAL) up to October 2008. The following key words were used: RT, myocardial infarction, reperfusion, primary angioplasty, glycoprotein IIb/IIIa inhibitors, abciximab, tirofiban, and eptifibatide. Concerning tirofiban, we only included trials or groups of patients with high-dose bolus and infusion. The primary end point was 30-day mortality. Secondary end points were 30-day reinfarction, post-procedural Thrombolysis In Myocardial Infarction (TIMI) flow grade 3, and ST-segment resolution.

RESULTS

A total of 6 RTs were included in the meta-analysis, involving 2,197 patients (1,082 randomized to abciximab and 1,115 to small molecules [high-dose tirofiban in 5 trials and eptifibatide in 1 trial]). Abciximab did not improve post-procedural TIMI flow grade 3 (89.8% vs. 89.1%, p = 0.72) or ST-segment resolution (67.8% vs. 68.2%, p = 0.66). Abciximab did not reduce 30-day mortality (2.2% vs. 2.0%, p = 0.66) or reinfarction (1.2% vs. 1.2%, p = 0.88), nor was there any difference in major bleeding complications (1.3% vs. 1.9%, p = 0.27).

CONCLUSIONS

This meta-analysis shows among STEMI patients undergoing PPCI similar results between abciximab and small molecules in terms of angiographic, electrocardiographic, and clinical outcome.

摘要

目的

本研究旨在对随机试验（RTs）进行荟萃分析，比较在ST段抬高型心肌梗死（STEMI）的直接经皮冠状动脉介入治疗（PPCI）中阿昔单抗与小分子药物（依替巴肽和替罗非班）的疗效。

背景

阿昔单抗已被证明在STEMI的PPCI中能带来显著益处。然而，小分子药物因抑制血小板聚集的可逆性及较低成本而成为一种有吸引力的策略。

方法

我们获取了在PPCI中比较阿昔单抗与小分子药物的RTs结果。通过检索截至2008年10月的电子数据库（MEDLINE和CENTRAL）来扫描文献。使用了以下关键词：RT、心肌梗死、再灌注、直接经皮冠状动脉介入治疗、糖蛋白IIb/IIIa抑制剂、阿昔单抗、替罗非班和依替巴肽。关于替罗非班，我们仅纳入了高剂量推注和输注的试验或患者组。主要终点是30天死亡率。次要终点是30天再梗死、术后心肌梗死溶栓（TIMI）血流3级以及ST段回落。

结果

荟萃分析共纳入6项RTs，涉及2197例患者（1082例随机接受阿昔单抗治疗，1115例接受小分子药物治疗[5项试验中使用高剂量替罗非班，1项试验中使用依替巴肽]）。阿昔单抗并未改善术后TIMI血流3级（89.8%对89.1%，p = 0.72）或ST段回落（67.8%对68.2%，p = 0.66）。阿昔单抗未降低30天死亡率（2.2%对2.0%，p = 0.66）或再梗死率（1.2%对1.2%，p = 0.88），主要出血并发症也无差异（1.3%对1.9%，p = 0.27）。