在冠状动脉支架之前提克洛皮丁预治疗与心脏不良事件的持续减少有关:来自对血小板IIb/IIIa抑制剂进行支架 (EPISTENT) 试验的评估数据
S R Steinhubl1, S G Ellis, K Wolski
1Department of Cardiology, Wilford Hall Medical Center, Lackland AFB, TX 78236, USA. steven.steinhubl@59MDW.WHMC.AF.MIL
Circulation
|March 14, 2001
概括
在冠状动脉支架之前,提克洛皮丁的预治疗显著降低了冠状动脉支架发生的血栓事件,并在没有接受abciximab的患者中减少了对目标血管再血管化的需要. 这种增强的抗血小板保护需要进一步调查,以改善患者的治疗结果.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
- 干预心脏病学 干预心脏病学
背景情况:
- 穿皮冠状动脉干预 (PCI) 需要有效的血小板抑制来预防血栓事件.
- 虽然PCI降低了血栓形成的风险,但它并不能始终预防复.
- 在PCI之前提升抗血小板治疗与提克洛皮丁预治疗的益处仍未得到充分研究.
研究的目的:
- 调查提克洛皮丁预治疗在减少冠状动脉支架后早期和晚期并发症中的作用.
- 在PCI的背景下,评估提克洛皮丁增强抗血小板保护的疗效.
主要方法:
- 这项研究分析了评估血小板IIb/IIIa抑制剂用于支架 (EPISTENT) 试验的数据.
- 大约有1600名接受支架的患者随机分配给接受安慰剂或abciximab,以及阿司匹林和肝素.
- 提克洛皮丁在手术后进行,而58%的人在医生的裁量下接受了支架前的治疗.
主要成果:
- 在安慰剂接受者中,提克洛皮丁预治疗显著降低了1年死亡,心肌梗塞或目标血管再血管化 (TVR) 的复合终点 (HR,0.73;P=.036).
- 在接受abciximab的患者中,提克罗匹丁预治疗没有显著影响死亡率或心肌梗塞率.
- 考克斯回归确定了提克洛皮丁预治疗作为在安慰剂和阿布西西马布组1年内减少TVR的独立预测因子 (HR,0.62;P=.010).
结论:
- 在PCI之前用提克洛皮丁进行预治疗与未接受abciximab的患者12个月复合终点的显著降低有关.
- 提克洛皮丁预治疗独立地预测,在所有支架患者中,1年后对TVR的需求较低.
- 增强的抗血小板保护提克洛皮丁在支架之前可以通过减少TVR来改善结果.
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