Hansen Peter Riis, Iversen Allan, Abdulla Jawdat
Department of Cardiology P, Gentofte University Hospital, Niels Andersensvej 65, DK-2900 Hellerup, Denmark.
J Invasive Cardiol. 2010 Jun;22(6):278-82.
Intracoronary (IC) administration of abciximab may increase local drug levels by several orders of magnitude compared to intravenous (IV) treatment and may improve clinical outcomes in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI). In the absence of results from large multicenter, randomized trials, we performed a systematic review and meta-analysis of available studies comparing IC to IV abciximab in these patients.
Eight studies were identified, including five randomized trials and three retrospective studies. Data from 2,301 patients, including 997 with ST-segment-elevation myocardial infarction (STEMI) and 1,304 with non-STEMI or unstable angina, were analyzed.
The studies were conducted from 1996-2008, 24% of patients had diabetes and thienopyridine pretreatment was frequently suboptimal, compared to the current standard of care. Pooled analysis of the data demonstrated significantly reduced mortality (odds ratio [OR] 0.57, 95% confidence interval [CI] 0.35-0.94; p = 0.028), and a trend toward a reduction of major adverse cardiac events (MACE, OR 0.62, 95% CI 0.38-1.03; p = 0.066) during up to 12 months of follow up with IC compared to IV abciximab. Metaregression analysis of important covariables showed heterogeneity of individual study results because of different follow-up periods and inclusion of patients without STEMI. Subanalyses showed significant MACE reduction after 1 month of follow up, and in studies exclusively composed of patients with STEMI, respectively.
This first systematic review and meta-analysis of available studies suggests that compared to standard IV administration, IC abciximab can improve clinical outcomes in patients with ACS undergoing PCI, especially patients with STEMI undergoing primary PCI.
与静脉注射（IV）治疗相比，冠状动脉内（IC）注射阿昔单抗可使局部药物水平提高几个数量级，并且可能改善接受经皮冠状动脉介入治疗（PCI）的急性冠状动脉综合征（ACS）患者的临床结局。在缺乏大型多中心随机试验结果的情况下，我们对比较IC与IV阿昔单抗治疗这些患者的现有研究进行了系统评价和荟萃分析。
共识别出8项研究，包括5项随机试验和3项回顾性研究。分析了2301例患者的数据，其中包括997例ST段抬高型心肌梗死（STEMI）患者和1304例非STEMI或不稳定型心绞痛患者。
这些研究于1996年至2008年进行，与当前的治疗标准相比，24%的患者患有糖尿病，噻吩吡啶预处理往往未达到最佳效果。对数据的汇总分析显示，在长达12个月的随访中，与IV阿昔单抗相比，IC阿昔单抗可显著降低死亡率（优势比[OR]0.57，95%置信区间[CI]0.35-0.94；p = 0.028），并且有降低主要不良心脏事件（MACE）的趋势（OR 0.62，95%CI 0.38-1.03；p = 0.066）。对重要协变量的Meta回归分析显示，由于随访期不同以及纳入了非STEMI患者，各研究结果存在异质性。亚组分析显示，随访1个月后以及在仅由STEMI患者组成的研究中，MACE显著降低。
这项对现有研究的首次系统评价和荟萃分析表明，与标准IV给药相比，IC阿昔单抗可改善接受PCI的ACS患者的临床结局，尤其是接受直接PCI的STEMI患者。
