Rakowski Tomasz, Siudak Zbigniew, Dziewierz Artur, Birkemeyer Ralf, Legutko Jacek, Mielecki Waldemar, Depukat Rafal, Janzon Magnus, Stefaniak Justyna, Zmudka Krzysztof, Dubiel Jacek S, Partyka Lukasz, Dudek Dariusz
2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
Am Heart J. 2009 Oct;158(4):569-75. doi: 10.1016/j.ahj.2009.08.008.
There are conflicting data on the clinical benefit from early administration of abciximab from a large randomized trial and a registry. However, both sources suggest that a benefit may depend on the baseline risk profile of the patients. We evaluated the role of early abciximab administration in patients with ST-segment-elevation myocardial infarction (STEMI) referred for primary percutaneous coronary intervention stratified by the STEMI Thrombolysis In Myocardial Infarction (TIMI) risk score.
A total of 1,650 patients were enrolled into the EUROTRANSFER Registry. One thousand eighty-six patients received abciximab (66%). Abciximab was administered early in 727 patients (EA) and late in 359 patients (LA). We used the TIMI risk score for risk stratification. Patients with scores >or=3 constituted the high-risk group of 616 patients (56.7%), whereas 470 patients formed the low-risk cohort. Factoring in the timing of the abciximab administration resulted in 4 groups of patients who were compared for mortality at 1 year: EA/high-risk (n = 413); LA/high-risk (n = 203); EA/low-risk (n = 314); LA/low-risk (n = 156). Baseline difference was accounted for by means of propensity score.
In high-risk patients, 1-year mortality was significantly lower with early abcximab compared to late administration (8.7% vs 15.8%; odds ratio 0.51, CI 0.31-0.85, P = .01). In multivariable Cox regression analysis, both early abciximab administration and patients' risk profile (TIMI score >or=3) were identified as independent predictors of 1-year mortality.
Early abciximab administration before transfer for percutaneous coronary intervention in STEMI shows lower mortality at 1-year follow-up. This effect is confined to patients with higher risk profile as defined by TIMI risk score >or=3.
一项大型随机试验和一项登记研究关于早期使用阿昔单抗的临床获益的数据相互矛盾。然而，这两个来源均表明获益可能取决于患者的基线风险特征。我们评估了早期使用阿昔单抗在接受直接经皮冠状动脉介入治疗的ST段抬高型心肌梗死（STEMI）患者中的作用，这些患者根据心肌梗死溶栓治疗（TIMI）风险评分进行了分层。
共有1650例患者纳入欧洲转运登记研究。1086例患者接受了阿昔单抗治疗（66%）。727例患者早期使用阿昔单抗（EA），359例患者晚期使用阿昔单抗（LA）。我们使用TIMI风险评分进行风险分层。评分≥3分的患者构成616例高风险组患者（56.7%），而470例患者形成低风险队列。考虑阿昔单抗给药时间后，将患者分为4组，比较1年时的死亡率：EA/高风险组（n = 413）；LA/高风险组（n = 203）；EA/低风险组（n =
