穿皮冠状动脉干预前的β-阻断剂不会减弱术后的肌激酶异酶升
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
概括
在穿皮冠状动脉干预 (PCI) 之前使用β-阻断剂 (BB) 并没有减少肌心损伤,根据肌酸酶 (CK) 和CK-MB水平进行测量. 这项大型观察性研究在风险调整后发现心脏酶升高没有显著差异.
科学领域:
- 心脏病学 心脏病学
- 临床研究 临床研究
- 药理学 药理学是指药理学的学科.
背景情况:
- 已知β-阻断剂 (BB) 的使用可减少非再流动性心肌梗塞中心脏病发作的大小.
- 它对接受再输血治疗的患者的心脏病大小的影响,例如皮肤冠状动脉干预 (PCI),不太清楚.
- 以前的研究表明,与PCI同时使用BB可能会降低肌酸激酶 (CK) -MB的升高,但需要进行强有力的风险调整.
研究的目的:
- 评估PCI前使用β阻塞剂 (BB) 与心肌损伤之间的关联.
- 要确定在PCI之前使用BB是否会影响肌酸激酶 (CK) 和CK-MB水平.
- 评估BBs对接受PCI的患者心肌损伤的影响,并考虑基线差异.
主要方法:
- 一项大型观察性研究分析了连续6200名接受PCI的患者.
- 倾向性得分和多变量回归分析被用于调整与没有BB治疗的患者之间的基线差异.
- 评估了与BB使用相关的肌酸激酶 (CK) 和CK-MB的每协议测量.
主要成果:
- 与不接受BBs的患者相比,接受BBs的患者的CK和CK-MB基线水平显著更高.
- 尽管BB组的基线酶水平较高,但调整后,最大CK和CK-MB水平在组之间没有显著差异.
- 统计分析显示,BB用户和非用户之间的最大CK上升 (P=0.21) 或最大CK-MB上升 (P=0.99) 没有显著差异.
结论:
- 这项研究的结果不支持在PCI之前使用β-阻断剂可以减少心肌损伤的假设.
- 在BB用户中观察到较高的CK和CK-MB水平可能是由于基线差异,而不是BB对心脏病发作大小的直接影响.
- 目前的证据不支持在PCI之前进行常规BB使用,以限制心肌损伤.
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