Rokyta R, Pechman V, Tousek P, Pudil R, Lhotska J, Widimsky P
Department of Cardiology, University Hospital Plzen, Faculty of Medicine Plzen;
Exp Clin Cardiol. 2013 Spring;18(2):81-4.
The clinical outcome of patients with myocardial infarction (MI) complicated by cardiogenic shock (CS) who require mechanical ventilation (MV) is poor.
To analyze the impact of abciximab pretreatment in this high-risk population of MI patients.
The present study was a retrospective subanalysis of the multicentre randomized Routine Upfront Abciximab Versus Standard Peri-Procedural Therapy in Patients Undergoing Percutaneous Coronary Intervention for Cardiogenic Shock (PRAGUE-7) study, which included 80 MI patients in CS undergoing primary percutaneous coronary intervention (PCI). Patients were randomly assigned into group A (routine pretreatment with an abciximab bolus followed by a 1 h abciximab infusion) and group B (standard therapy). The subanalysis included 37 patients requiring MV. Seventeen patients were in group A and 20 were in group B. The primary end point (death/stroke/reinfarction/new severe renal failure) at 30 days, procedural success (thrombosis in myocardial infarction [TIMI] flow) and frequency of bleeding were assessed. The χ(2) and Student's t tests were used for statistical analysis; P<0.05 was considered to be statistically significant.
The primary end point occurred in nine (53%) patients in group A and 12 (60%) patients in group B (P=0.66). TIMI flow after primary PCI was higher in group A (2.75 versus 2.31; P<0.05). Major bleeding occurred in 12% of patients in group A versus 10% of patients in group B (P=0.86). Minor or minimal bleeding was more common in group A (29%) compared with group B (5%; P<0.05).
The results of the present study suggest that routine pretreatment with abciximab before primary PCI in mechanically ventilated patients with MI complicated by cardiogenic shock was associated with better angiographic results but also with a higher incidence of bleeding.
心肌梗死（MI）合并心源性休克（CS）且需要机械通气（MV）的患者临床结局较差。
分析阿昔单抗预处理对这类高危MI患者群体的影响。
本研究是对多中心随机进行的“经皮冠状动脉介入治疗心源性休克患者中阿昔单抗常规早期应用与标准围手术期治疗比较（PRAGUE - 7）”研究的回顾性亚组分析，该研究纳入了80例接受直接经皮冠状动脉介入治疗（PCI）的心源性休克MI患者。患者被随机分为A组（阿昔单抗推注进行常规预处理，随后输注1小时阿昔单抗）和B组（标准治疗）。亚组分析纳入了37例需要机械通气的患者。A组17例，B组20例。评估30天时的主要终点（死亡/卒中/再梗死/新发严重肾衰竭）、手术成功率（心肌梗死溶栓[TIMI]血流）和出血频率。采用χ²检验和t检验进行统计分析；P<0.05被认为具有统计学意义。
主要终点在A组9例（53%）患者和B组12例（60%）患者中出现（P = 0.66）。A组直接PCI后的TIMI血流更高（2.75对2.31；P<0.05）。A组12%的患者发生大出血，B组为10%的患者（P = 0.86）。与B组（5%）相比，轻微或少量出血在A组更常见（29%；P<0.05）。
本研究结果表明，在机械通气的心肌梗死合并心源性休克患者中，直接PCI前常规应用阿昔单抗预处理与更好的血管造影结果相关，但出血发生率也更高。
