Department of Geriatrics, Southwest Hospital, The Third Military Medical University, Chongqing 400038, China.
Int J Cardiol. 2013 Jan 20;162(3):210-9. doi: 10.1016/j.ijcard.2012.06.001. Epub 2012 Jul 4.
Glycoprotein (Gp) IIb/IIIa inhibitors are beneficial for patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). However, optimal drug timing remains inconclusive. Therefore, this study was to perform a meta-analysis of the clinical efficiency and safety of early versus late GpIIb/IIIa inhibitors in STEMI patients undergoing PCI.
A comprehensive search was to identify randomized trials of early versus late GpIIb/IIIa inhibitors in STEMI patients undergoing PCI. The GpIIb/IIIa inhibitors were abciximab and small-molecular Gp inhibitors (SMGP) namely eptifibatide and tirofiban. The efficacy endpoints included pre-procedural Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow, post-procedural TIMI 3 flow, complete ST-segment resolution, left ventricle ejection fraction (LVEF), and mortality. The safety endpoint was the occurrence of major bleeding complications.
Nineteen trials were included in the meta-analysis, involving 4209 patients (early 2124 versus late 2085). Early GpIIb/IIIa inhibitors significantly improved pre-procedural TIMI 3 flow, while early abciximab, but not SMGP, further enhanced post-procedural TIMI 3 flow, complete ST-segment resolution, LVEF, and reduced six-month mortality. In addition to clopidogrel loading, only early abciximab improved pre-procedural TIMI 3 flow and complete ST-segment resolution. The rate of major bleeding complications was not increased in early GpIIb/IIIa inhibitors with/without clopidogrel loading.
Early GpIIb/IIIa inhibitors improved pre-procedural TIMI 3 flow and early abciximab provided favorable clinical outcomes in STEMI patients undergoing PCI. On the basis of clopidogrel loading, early abciximab enhanced pre-procedural TIMI 3 flow and ST-segment resolution. These beneficial effects were achieved without increased risks of major bleeding complications.
糖蛋白（Gp）IIb/IIIa 抑制剂对接受经皮冠状动脉介入治疗（PCI）的 ST 段抬高型心肌梗死（STEMI）患者有益。然而，最佳药物时机仍不确定。因此，本研究旨在对 STEMI 患者接受 PCI 时早期与晚期 GpIIb/IIIa 抑制剂的临床疗效和安全性进行荟萃分析。
全面检索比较 STEMI 患者接受 PCI 时早期与晚期 GpIIb/IIIa 抑制剂的随机试验。GpIIb/IIIa 抑制剂为阿昔单抗和小分子 Gp 抑制剂（SMGP），即依替巴肽和替罗非班。疗效终点包括术前血栓溶解心肌梗死（TIMI）3 级血流、术后 TIMI 3 级血流、完全 ST 段缓解、左心室射血分数（LVEF）和死亡率。安全性终点为主要出血并发症的发生情况。
共纳入 19 项荟萃分析，共纳入 4209 例患者（早期 2124 例，晚期 2085 例）。早期 GpIIb/IIIa 抑制剂可显著改善术前 TIMI 3 级血流，而早期阿昔单抗而非 SMGP 进一步提高术后 TIMI 3 级血流、完全 ST 段缓解、LVEF，降低 6 个月死亡率。除氯吡格雷负荷量外，仅早期阿昔单抗可改善术前 TIMI 3 级血流和完全 ST 段缓解。在氯吡格雷负荷量的情况下，早期 GpIIb/IIIa 抑制剂并未增加主要出血并发症的发生率。
早期 GpIIb/IIIa 抑制剂可改善 STEMI 患者 PCI 术前 TIMI 3 级血流，早期阿昔单抗可改善 PCI 患者的临床结局。在氯吡格雷负荷量的基础上，早期阿昔单抗可增强术前 TIMI 3 级血流和 ST 段缓解，且不增加主要出血并发症的风险。
