糖尿病合并ST段抬高型心肌梗死患者行直接经皮冠状动脉介入治疗时冠状动脉内注射阿昔单抗的研究

Intracoronary abciximab in diabetic patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

作者信息

Piccolo Raffaele, Eitel Ingo, Galasso Gennaro, Iversen Allan Zeeberg, Gu Youlan L, Dominguez-Rodriguez Alberto, de Smet Bart J G L, Mahmoud Karim D, Abreu-Gonzalez Pedro, Thiele Holger, Piscione Federico

机构信息

Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.

Heart Center, Department of Internal Medicine, Cardiology, University of Leipzig, Leipzig, Germany.

出版信息

Vascul Pharmacol. 2015 Oct;73:32-7. doi: 10.1016/j.vph.2015.06.001. Epub 2015 Jun 10.

DOI:10.1016/j.vph.2015.06.001

PMID:26071862

Abstract

BACKGROUND

Although intracoronary abciximab failed to improve prognosis compared with intravenous route in unselected ST-segment elevation myocardial infarction (STEMI) patients, little is known about the role of intracoronary abciximab in diabetic patients.

OBJECTIVES

To evaluate the efficacy of intracoronary abciximab administration in diabetic patients with STEMI undergoing primary percutaneous coronary intervention (PCI).

METHODS

Reperfusional and clinical outcomes of intracoronary abciximab compared with intravenous bolus abciximab according to diabetic status were evaluated in a pooled analysis of five randomized trials including 3158 STEMI patients. The primary clinical endpoint of the study was the composite of death or reinfarction at 30-day follow-up.

RESULTS

Among 584 diabetic patients (18.5%), the composite of death or reinfarction was significantly reduced with intracoronary abciximab compared to intravenous abciximab (4.7% vs. 8.8%; rate ratio [RR], 0.50; 95% confidence intervals [CI], 0.26-0.99; p=0.04), driven by numerically lower deaths (3.7% vs. 6.4%; RR, 0.56; 95% CI, 0.26-1.20; p=0.13). Moreover, a significant reduction in definite or probable stent thrombosis was observed in patients receiving intracoronary abciximab (1% vs. 3.5%; RR, 0.27; 95% CI, 0.07-0.99; p=0.04). Although formal tests for interaction were not significant, no clinical benefit was apparent in the cohort of STEMI patients without diabetes (n=2574).

CONCLUSIONS

In diabetic patients with STEMI undergoing primary PCI, intracoronary abciximab may improve clinical outcomes as compared with standard intravenous use. These findings require confirmation in a dedicated randomized trial.

摘要

背景

尽管在未选择的ST段抬高型心肌梗死（STEMI）患者中，与静脉途径相比，冠状动脉内使用阿昔单抗未能改善预后，但关于冠状动脉内使用阿昔单抗在糖尿病患者中的作用知之甚少。

目的

评估冠状动脉内给予阿昔单抗对接受直接经皮冠状动脉介入治疗（PCI）的糖尿病STEMI患者的疗效。

方法

在一项纳入3158例STEMI患者的五项随机试验的汇总分析中，根据糖尿病状态评估冠状动脉内阿昔单抗与静脉推注阿昔单抗的再灌注和临床结局。该研究的主要临床终点是30天随访时的死亡或再梗死复合终点。

结果

在584例糖尿病患者（18.5%）中，与静脉注射阿昔单抗相比，冠状动脉内使用阿昔单抗显著降低了死亡或再梗死复合终点（4.7%对8.8%；率比[RR]，0.50；95%置信区间[CI]），0.26 - 0.99；p = 0.04），主要是死亡人数在数值上较低（3.7%对6.4%；RR，0.56；95% CI，0.26 - 1.20；p = 0.13）。此外，接受冠状动脉内阿昔单抗的患者中明确或可能的支架血栓形成显著减少（1%对3.5%；RR，0.27；95% CI，0.07 - 0.99；p = 0.04）。尽管交互作用的正式检验不显著，但在无糖尿病的STEMI患者队列（n = 2574）中未观察到临床益处。