在ST段升高心肌梗塞患者的静脉内红素:REVEAL:一项随机对照试验
Samer S Najjar1, Sunil V Rao, Chiara Melloni
1Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA. Samer.S.Najjar@medstar.net
JAMA
|May 12, 2011
概括
在再注射后,阿尔法素在ST段升高心肌梗塞 (STEMI) 患者中没有减少心脏病发作的大小. 治疗与心血管不良事件的增加有关,特别是在老年人中.
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.
- 临床试验 临床试验
背景情况:
- 急性ST段升高心肌梗塞 (STEMI) 是死亡和残疾的重要原因.
- 素在实验模型中显示出降低心脏病发作大小和改善心肌梗塞 (MI) 后左心室功能的前景.
研究的目的:
- 评估一次性静脉注射剂量阿尔法乙在经历STEMI的患者中的安全性和有效性.
- 为了确定阿尔法乙的使用是否会影响心脏病发作的大小和左心室重塑.
主要方法:
- 一项前性,随机,双盲,安慰剂对照试验 (REVEAL) 涉及222名接受皮肤冠状动脉干预 (PCI) 的STEMI患者.
- 患者在再输血后4小时内静脉注射阿尔法乙 (6万个单位) 或安慰剂.
- 用心磁共振成像 (CMR) 在两个时间点测量心脏梗塞大小:干预后早期和12周后.
主要成果:
- 在早期或晚期的CMR评估中,在阿尔法乙和安慰剂组之间没有观察到心脏病发作大小的显著差异.
- 预先规定的分析表明,与安慰剂相比,70岁或以上的患者接受阿尔法乙治疗时心脏病发作的大小较大 (P=.03).
- 综合性不良心血管事件 (死亡,心脏病发作,中风,支架血栓形成) 的发生率在阿尔法乙组 (4.0%) 比安慰剂组 (0%) (P=.04) 高.
结论:
- 在再注射4小时内,单次静脉注射阿尔法乙烯基乙,在STEMI患者中没有减少心脏病发作的大小.
- 治疗与心血管不良事件的风险增加有关.
- 人们担心老年患者治疗alpha. epoetin的潜在心脏病发作大小增加.
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