Kassaian Seyed Ebrahim, Fathi Yadollah, Lotfi-Tokaldany Masoumeh, Salarifar Mojtaba, Alidoosti Mohammad, Haji-Zeinali Ali-Mohammad, Aghajani Hassan, Amirzadegan Alireza, Nozari Younes, Mortazavi Seyedeh Hamideh, Jalali Arash, Saroukhani Sepideh
From the *Department of Interventional Cardiology, and †Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
Crit Pathw Cardiol. 2016 Sep;15(3):89-94. doi: 10.1097/HPC.0000000000000079.
The aim of this study is to compare intracoronary (IC) bolus only with IC bolus plus maintenance intravenous (IV) infusion of glycoprotein IIb/IIIa (GP IIb/IIIa) inhibitors with respect to 1-year major adverse cardiac events including mortality, nonfatal myocardial infarction, revascularization, and bleeding events after primary percutaneous coronary intervention (PCI).
This is an observational study of 233 consecutive patients who presented with ST-elevation myocardial infarction and underwent primary PCI between April 2009 and December 2012. Patients were grouped into (1) patients who received IC bolus only (n = 102) and (2) patients who received IC bolus plus maintenance IV infusion of GP IIb/IIIa inhibitors (n = 131). In-hospital post procedural myocardial infarction occurred in 4 (1.7 %) of patients.
Mortality occurred in one patient who was treated with IV infusion. Major bleeding occurred in only 5 patients, among whom 4 patients had received GP IIb/IIIa inhibitors IV infusion. However, the difference was not statistically significant (P = 0.389).
Both univariate analysis and the adjusted model for the potential confounders revealed no significant association between the way of GP IIb/IIIa inhibitors administration and 1-year major adverse cardiac events. Our findings suggested that IV infusion of GP IIb/IIIa inhibitors after the bolus dose is not associated with better 1-year outcome after adjustment for confounding variables. Moreover, IV infusion may increase the risk of major bleedings after primary PCI. This finding implies that the need for IV infusion of GP IIb/IIIa inhibitors in patients undergoing primary PCI is under question.
本研究旨在比较仅冠状动脉内（IC）推注糖蛋白IIb/IIIa（GP IIb/IIIa）抑制剂与IC推注加维持静脉（IV）输注GP IIb/IIIa抑制剂在1年主要不良心脏事件方面的差异，这些事件包括原发性经皮冠状动脉介入治疗（PCI）后的死亡率、非致命性心肌梗死、血管重建和出血事件。
这是一项对233例连续患者的观察性研究，这些患者于2009年4月至2012年12月期间出现ST段抬高型心肌梗死并接受了原发性PCI。患者被分为两组：（1）仅接受IC推注的患者（n = 102）和（2）接受IC推注加维持IV输注GP IIb/IIIa抑制剂的患者（n = 131）。4例（1.7%）患者在住院期间发生术后心肌梗死。
1例接受IV输注治疗的患者死亡。仅5例患者发生大出血，其中4例患者接受了GP IIb/IIIa抑制剂IV输注。然而，差异无统计学意义（P = 0.389）。
单因素分析和针对潜在混杂因素的校正模型均显示，GP IIb/IIIa抑制剂的给药方式与1年主要不良心脏事件之间无显著关联。我们的研究结果表明，在调整混杂变量后，推注剂量后IV输注GP IIb/IIIa抑制剂与1年更好的预后无关。此外，IV输注可能会增加原发性PCI后大出血的风险。这一发现意味着原发性PCI患者是否需要IV输注GP IIb/IIIa抑制剂存在疑问。
