Columbia University Medical Center, New York, New York.
Am J Cardiol. 2012 Oct 1;110(7):940-7. doi: 10.1016/j.amjcard.2012.05.026. Epub 2012 Jun 28.
There are limited safety and effectiveness data comparing glycoprotein IIb/IIIa inhibitors in the setting of primary percutaneous coronary intervention. In this substudy of the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial, the clinical and bleeding outcomes of eptifibatide versus abciximab were evaluated in patients with ST-segment elevation myocardial infarction who underwent percutaneous coronary intervention. Three-year clinical outcomes of patients in the heparin plus glycoprotein IIb/IIIa inhibitor arm were compared according to treatment with abciximab (n = 907) versus eptifibatide (n = 803). Adjudicated end points included major adverse cardiovascular events (MACEs; mortality, reinfarction, ischemia-driven target vessel revascularization, or stroke), major bleeding, and net adverse clinical events (MACEs or major bleeding). Propensity score matching was used to identify 1,342 matched cases (671 each in the abciximab and eptifibatide groups). Multivariate analysis was performed in the entire cohort and the propensity-matched groups. At 3-year follow-up, eptifibatide and abciximab resulted in nonsignificantly different rates of MACEs (18.3% vs 19.6%, hazard ratio [HR] 0.93, 95% confidence interval [CI] 0.74 to 1.16, p = 0.51), major bleeding (10.7% vs 11.9%, HR 0.90, 95% CI 0.67 to 1.19, p = 0.44), and net adverse clinical events (24.5% vs 25.5%, HR 0.96, 95% CI 0.79 to 1.17, p = 0.69). Similarly, at 3 years by multivariate analysis, there was no statistically significant difference between abciximab and eptifibatide for net adverse clinical events (HR 0.89, 95% CI 0.73 to 1.09, p = 0.27), MACEs (HR 0.96, 95% CI 0.77 to 1.20, p = 0.73), and major bleeding (HR 1.05, 95% CI 0.78 to 1.41, p = 0.75). The propensity-matched groups also had similar outcomes. In conclusion, abciximab and eptifibatide have comparable bleeding risks and clinical efficacy in primary percutaneous coronary intervention.
在直接经皮冠状动脉介入治疗中，比较糖蛋白 IIb/IIIa 抑制剂的安全性和有效性的数据有限。在 Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction（HORIZONS-AMI）试验的这项亚研究中，评估了替罗非班与阿昔单抗在接受经皮冠状动脉介入治疗的 ST 段抬高型心肌梗死患者中的临床和出血结局。根据肝素加糖蛋白 IIb/IIIa 抑制剂组中接受阿昔单抗（n=907）与替罗非班（n=803）治疗的情况，比较了患者的 3 年临床结局。裁定终点包括主要不良心血管事件（MACE；死亡率、再梗死、缺血驱动的靶血管血运重建或卒中）、大出血和净不良临床事件（MACE 或大出血）。采用倾向评分匹配确定了 1342 例匹配病例（阿昔单抗组和替罗非班组各 671 例）。在整个队列和倾向评分匹配的组中进行了多变量分析。在 3 年随访时，替罗非班和阿昔单抗的 MACE 发生率无显著差异（18.3%比 19.6%，风险比[HR]0.93，95%置信区间[CI]0.74 至 1.16，p=0.51）、大出血（10.7%比 11.9%，HR 0.90，95%CI 0.67 至 1.19，p=0.44）和净不良临床事件（24.5%比 25.5%，HR 0.96，95%CI 0.79 至 1.17，p=0.69）。同样，在多变量分析的 3 年时，阿昔单抗和替罗非班的净不良临床事件（HR 0.89，95%CI 0.73 至 1.09，p=0.27）、MACE（HR 0.96，95%CI 0.77 至 1.20，p=0.73）和大出血（HR 1.05，95%CI 0.78 至 1.41，p=0.75）无统计学显著差异。倾向评分匹配的组也有类似的结果。总之，在直接经皮冠状动脉介入治疗中，阿昔单抗和替罗非班的出血风险和临床疗效相当。
