早期应用阿昔单抗于直接经皮冠状动脉介入治疗对 ST 段抬高型心肌梗死合并糖尿病患者的临床转归的影响（EUROTRANSFER 注册研究）。

Early abciximab administration before primary percutaneous coronary intervention improves clinical outcome in diabetic patients with ST-segment elevation myocardial infarction (EUROTRANSFER Registry).

机构信息

Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland.

出版信息

Atherosclerosis. 2012 Jul;223(1):212-8. doi: 10.1016/j.atherosclerosis.2012.04.018. Epub 2012 May 15.

DOI:10.1016/j.atherosclerosis.2012.04.018

PMID:22658254

Abstract

BACKGROUND

Diabetes is an important determinant of prognosis in patients with ST-segment elevation myocardial infarction (STEMI). Limited data are available concerning benefits and risks of upstream abciximab administration in diabetic patients. Thus, the objective of the study was to assess the impact of early abciximab administration before primary angioplasty (PCI) for STEMI in diabetic patients.

METHODS

Data were gathered for 1650 consecutive STEMI patients transferred for primary PCI from hospital networks in seven countries in Europe from November 2005 to January 2007 (the EUROTRANSFER Registry population). Patients were stratified by diabetes mellitus presence and then by abciximab administration strategy (early - more than 30 min before PCI vs. late).

RESULTS

Diabetes mellitus was diagnosed in 262 (15.9%) patients. Patients with diabetes mellitus were high-risk individuals, with advanced age, higher prevalence of comorbidities and increased risk of ischemic events during follow-up in comparison to non-diabetic patients. A total of 1086 patients who received abciximab were identified. Strategy of early abciximab administration was associated with enhanced infarct-related artery patency before PCI, and improved epicardial flow after PCI in both diabetic and non-diabetic patients. Importantly, early abciximab in diabetic patients led to the decrease in ischemic events, including 30-day (OR 0.260, 95% CI 0.089-0.759, p = 0.012) and 1-year (OR 0.273, 95% CI 0.099-0.749, p = 0.012) mortality reduction. However, only a trend toward improved survival was confirmed after adjustment for potential confounders. On the contrary, the reduction of 30-day (OR 0.620, 95% CI 0.334-1.189, p = 0.16) and 1-year (OR 0.643, 95% CI 0.379-1.089, p = 0.10) mortality rates was not significant among non-diabetic patients.

CONCLUSIONS

Early administration of abciximab improves infarct-related artery patency before and after primary PCI, and leads to improved survival in diabetic STEMI patients.

摘要

背景

糖尿病是 ST 段抬高型心肌梗死（STEMI）患者预后的重要决定因素。关于糖尿病患者接受上游替罗非班治疗的益处和风险的数据有限。因此，本研究的目的是评估在 STEMI 患者中，直接经皮冠状动脉介入治疗（PCI）前早期应用替罗非班对患者的影响。

方法

本研究共纳入了 2005 年 11 月至 2007 年 1 月期间，来自欧洲 7 个国家的医院网络转院至行直接 PCI 的 1650 例连续 STEMI 患者（EUROTRANSFER 登记研究人群）。根据是否合并糖尿病及替罗非班应用策略（早期-PCI 前 30 分钟以上 vs. 晚期）对患者进行分层。

结果

共诊断出 262 例（15.9%）合并糖尿病的患者。与非糖尿病患者相比，合并糖尿病的患者为高危人群，年龄较大，合并症更常见，且随访期间发生缺血事件的风险更高。共纳入 1086 例接受替罗非班治疗的患者。与晚期组相比，早期应用替罗非班策略与 PCI 前梗死相关动脉的再通率增加，以及 PCI 后心外膜血流改善相关。重要的是，糖尿病患者早期应用替罗非班可降低缺血性事件发生率，包括 30 天（OR 0.260，95%CI 0.089-0.759，p = 0.012）和 1 年（OR 0.273，95%CI 0.099-0.749，p = 0.012）死亡率降低。然而，仅在调整潜在混杂因素后证实了生存获益的趋势。相反，在非糖尿病患者中，30 天（OR 0.620，95%CI 0.334-1.189，p = 0.16）和 1 年（OR 0.643，95%CI 0.379-1.089，p = 0.10）死亡率降低无统计学意义。