経皮冠動脈介入前のベータブロッカーは,処置後のクレアチンキナーゼイソエンザイム上昇を弱めません
S G Ellis1, S J Brener, A M Lincoff
1Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA. elliss@ccf.org
Circulation
|November 28, 2001
まとめ
経皮冠動脈介入 (PCI) 前のベータブロッカー (BB) の使用は,クレアチンキナーゼ (CK) とCK-MBレベルで測定されるように,心筋損傷を減少させなかった. この大規模な観察研究では,リスク調整後の心臓酵素上昇において有意な差は認められませんでした.
科学分野:
- 心臓病学 心臓病学
- クリニック・リサーチ 臨床研究
- 薬理学 薬理学とは
背景:
- ベータブロッカー (BB) の使用は,非再発性心筋梗塞における心臓発作のサイズを減らすことが知られている.
- 経皮冠動脈干渉 (PCI) などの再注射療法を受けている患者の心臓発作のサイズに対するその影響は,それほど明確ではありません.
- 以前の研究では,PCIとBBの併用は,クレアチンキナーゼ (CK) -MBの上昇を低下させる可能性があるが,強力なリスク調整が必要だと示唆されていた.
研究 の 目的:
- PCI前ベータブロッカー (BB) の使用と心筋損傷との関連を評価する.
- PCI前のBB使用がクレアチンキナーゼ (CK) とCK-MBレベルに影響するかどうかを判断する.
- ベースラインの差異を考慮して,PCIを受ける患者の心筋損傷に対するBBの影響を評価する.
主な方法:
- 大規模な観察研究では,PCIを受けた6200人の連続した患者を分析した.
- 傾向性スコアと多変数回帰分析を用いて,BB治療を受けた患者と受けなかった患者の基値差を調整した.
- クレアチンキナーゼ (CK) とCK-MBのプロトコル毎の測定は,BB使用に関連して評価されました.
主要な成果:
- BBsを受けた患者は,BBsを受けていない患者と比較して,CKとCK-MBのベースラインレベルが著しく高かった.
- BBグループでは基値より高い酵素濃度にもかかわらず,最大CKとCK-MB濃度は調整後のグループ間で有意に異なるものではありませんでした.
- 統計分析では,BBユーザーと非ユーザーの間で最大CK上昇 (P=0.21) または最大CK-MB上昇 (P=0.99) の有意な差異は示されなかった.
結論:
- この研究の結果は,PCIの前にベータブロッカーの使用が心筋梗塞の損傷を減少させるという仮説を支持しません.
- BB使用者における高濃度のCKとCK-MBは,おそらくベースラインの差異によるもので,BBが心臓発作のサイズに直接的な影響を与えているわけではない.
- 現在の証拠は,心筋損傷を制限するためにPCIの前にBBを日常的に使用することを推奨していません.
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