Mak K H, Challapalli R, Eisenberg M J, Anderson K M, Califf R M, Topol E J
Department of Cardiology, The Cleveland Clinic Foundation, Ohio 44195, USA.
Am J Cardiol. 1997 Oct 15;80(8):985-8. doi: 10.1016/s0002-9149(97)00589-4.
Percutaneous treatment of narrowed aortocoronary saphenous vein graft disease represents a viable option for patients with recurrent angina following coronary artery bypass grafting. Present strategies are limited by high rates of distal embolization, non-Q-wave acute myocardial infarction (AMI), and restenosis. Because these complications may be mediated by platelets, inhibition of platelet glycoprotein IIb/IIIa receptor, the final common pathway for aggregation, may improve clinical outcomes. In the Evaluation of IIb/IIIa platelet receptor antagonist 7E3 in Preventing Ischemic Complications (EPIC) trial, 2,099 patients undergoing high-risk percutaneous coronary revascularization were randomized to receive abciximab bolus and infusion, abciximab bolus followed by placebo infusion or placebo. A total of 101 patients were treated for narrowing of saphenous vein grafts, 38 in the bolus and infusion group, 34 in the bolus group and 29 in the placebo group. Clinical end points included all-cause mortality, nonfatal AMI and need for repeat revascularization at 30 days. Compared with placebo, bolus and infusion therapy resulted in a significant reduction in distal embolization (2% vs 18%, p = 0.017) and a trend towards reduction in early large non-Q-wave AMI (2% vs 12%, p = 0.165). The occurrence of a 30-day composite end point was similar among the 3 treatment groups. At 6 months, there was also no difference in the composite end point. These results suggest that adjunctive therapy with abciximab during percutaneous treatment of narrowed saphenous vein grafts reduces the occurrence of distal embolization, and possibly non-Q-wave AMI.
经皮治疗狭窄的主动脉冠状动脉大隐静脉移植血管疾病是冠状动脉旁路移植术后复发性心绞痛患者的一种可行选择。目前的治疗策略受到远端栓塞、非Q波急性心肌梗死（AMI）和再狭窄的高发生率的限制。由于这些并发症可能由血小板介导，抑制血小板糖蛋白IIb/IIIa受体（聚集的最终共同途径）可能会改善临床结果。在“评估IIb/IIIa血小板受体拮抗剂7E3预防缺血性并发症（EPIC）试验”中，2099例接受高危经皮冠状动脉血运重建的患者被随机分为接受阿昔单抗推注和输注组、阿昔单抗推注后接受安慰剂输注组或安慰剂组。共有101例患者接受了大隐静脉移植血管狭窄的治疗，推注和输注组38例，推注组34例，安慰剂组29例。临床终点包括30天时的全因死亡率、非致命性AMI和再次血运重建的需求。与安慰剂相比，推注和输注治疗导致远端栓塞显著减少（2%对18%，p = 0.017），早期大型非Q波AMI有减少趋势（2%对12%，p = 0.165）。3个治疗组30天复合终点的发生率相似。在6个月时，复合终点也没有差异。这些结果表明，在经皮治疗狭窄的大隐静脉移植血管时，阿昔单抗辅助治疗可减少远端栓塞的发生，并可能减少非Q波AMI的发生。
