Whether the benefits that glycoprotein IIb/IIIa inhibitors confer in patients who undergo baremetal stent implantation extend to drug-eluting stents is unknown. We performed a prespecified subgroup analysis of the TAX...Whether the benefits that glycoprotein IIb/IIIa inhibitors confer in patients who undergo baremetal stent implantation extend to drug-eluting stents is unknown. We performed a prespecified subgroup analysis of the TAXUS IV study population to examine the effect of procedural glycoprotein IIb/IIIa inhibition during paclitaxel-eluting stent implantation on periprocedural creatine kinase-MB(CK-MB) levels. Glycoprotein(GP)IIb/IIIa inhibitors were administered to 57.7%of patients who had been randomized to receive the TAXUS stent and to 56.7%of those who had been randomized to receive the control stent. Among patients who received the TAXUS stent, the rate of CKMB increases of >3 times the normal level was 2.6-fold higher in those who received a GP IIb/IIIa inhibitor than in those who did not(11.4%vs 4.4%, p=0.0015). Composite rates of major adverse cardiac events and target vessel failure were also higher at 1 month in the GP IIb/IIIa group. By multivariate analysis, use of GP IIb/IIIa inhibitors during stenting with the TAXUS stent was an independent predictor of CK-MB increases >3 times the normal level. Further studies are warranted.展开更多
Aims: Although embolic protection devices reduce complications during saphenous vein graft(SVG) stenting, adverse events still occur in ～10%of patients. IIb/IIIa antagonists have not been proven effective during SVG ...Aims: Although embolic protection devices reduce complications during saphenous vein graft(SVG) stenting, adverse events still occur in ～10%of patients. IIb/IIIa antagonists have not been proven effective during SVG intervention. We hypothesized that adjunctive use of these agents might enhance the efficacy of embolic protection devices. Methods and results: In the prospective, multicentre FilterWire EX Randomized Evaluation trial, 651 patients undergoing SVG stenting were randomized to either filter-based FilterWire EX or balloon occlusion/aspiration GuardWire embolic protection devices. IIb/IIIa inhibitor use was at the discretion of the investigator, with randomization stratified by intended use. Patients pre-selected for IIb/IIIa inhibitor use(n=345) had higher baseline risk, with increased 30-day major adverse cardiac events(MACE, 13.0 vs. 8.0%, P=0.03). GuardWire assigned patients treated with IIb/IIIa inhibitors had higher 30-day MACE compared with those not treated with IIb/IIIa inhibitors(16.0 vs. 6.3%, P=0.007). In contrast, MACE in high-risk FilterWire patients treated with IIb/IIIa inhibitors were similar to their lower risk, untreated counterparts(9.9 vs. 9.5%, P=0.89). Multivariable analysis detected a borderline significant(P=0.056) interaction for lower MACE between FilterWire and IIb/ IIIa inhibitor use. Adjustment by the propensity to use IIb/IIIa inhibitors resulted in a significant(P=0.023) interaction for lower MACE rates. IIb/IIIa inhibition in conjunction with FilterWire was associated with less abrupt closure, no reflow, or distal embolization. Conclusion: IIb/IIIa antagonists may improve procedural outcome during SVG stenting in high risk patients, utilizing filter-based embolic protection devices.展开更多
目的观察不同血管分型的进展性缺血性脑卒中(PIS)的基线特征及应用替罗非班的临床效果。方法回顾性选取2020年3月—2022年3月湘潭市中心医院收治的PIS患者89例,根据治疗方法不同分为观察组42例和对照组47例。对照组患者予以常规治疗及...目的观察不同血管分型的进展性缺血性脑卒中(PIS)的基线特征及应用替罗非班的临床效果。方法回顾性选取2020年3月—2022年3月湘潭市中心医院收治的PIS患者89例,根据治疗方法不同分为观察组42例和对照组47例。对照组患者予以常规治疗及阿司匹林100 mg联合氢氯吡格雷75 mg抗血小板聚集,观察组患者在对照组基础上加用替罗非班治疗,根据责任血管(小动脉闭塞型和大动脉粥样硬化型)进一步亚组分析,比较各组NIHSS评分、住院时间,随访90 d,比较各组mRS评分、焦虑、抑郁及胃肠道出血发生率。结果观察组与对照组及各亚组基线特征、入院时NIHSS评分、加重时NIHSS评分比较差异均无统计学意义(P>0.05);观察组治疗7 d后NIHSS评分低于对照组,ΔNIHSS评分及随访90 d mRS评分良好率高于对照组,住院时间短于对照组(P<0.05)。根据责任血管分型的亚组分析显示,在小动脉闭塞亚组中,观察亚组加重7 d后的NIHSS评分低于对照亚组,ΔNIHSS评分及随访90 d mRS评分良好率高于对照亚组,住院时间短于对照亚组(P<0.05);而在大动脉粥样硬化亚组中,2亚组患者基线特征、入院时NIHSS评分、加重时NIHSS评分、治疗7 d后NIHSS评分、ΔNIHSS评分、住院时间及随访90 d mRS评分良好率比较差异均无统计学意义(P>0.05)。随访90 d,观察组与对照组及各亚组焦虑、抑郁、胃肠道出血发生率比较差异均无统计学意义(P>0.05)。结论与口服抗血小板药物比较,替罗非班对不同责任血管导致的PIS疗效可能存在差异,替罗非班可显著改善小动脉闭塞型PIS的神经功能缺损,疗效确切,且安全性高,值得推广应用。展开更多
文摘Whether the benefits that glycoprotein IIb/IIIa inhibitors confer in patients who undergo baremetal stent implantation extend to drug-eluting stents is unknown. We performed a prespecified subgroup analysis of the TAXUS IV study population to examine the effect of procedural glycoprotein IIb/IIIa inhibition during paclitaxel-eluting stent implantation on periprocedural creatine kinase-MB(CK-MB) levels. Glycoprotein(GP)IIb/IIIa inhibitors were administered to 57.7%of patients who had been randomized to receive the TAXUS stent and to 56.7%of those who had been randomized to receive the control stent. Among patients who received the TAXUS stent, the rate of CKMB increases of >3 times the normal level was 2.6-fold higher in those who received a GP IIb/IIIa inhibitor than in those who did not(11.4%vs 4.4%, p=0.0015). Composite rates of major adverse cardiac events and target vessel failure were also higher at 1 month in the GP IIb/IIIa group. By multivariate analysis, use of GP IIb/IIIa inhibitors during stenting with the TAXUS stent was an independent predictor of CK-MB increases >3 times the normal level. Further studies are warranted.
文摘Aims: Although embolic protection devices reduce complications during saphenous vein graft(SVG) stenting, adverse events still occur in ～10%of patients. IIb/IIIa antagonists have not been proven effective during SVG intervention. We hypothesized that adjunctive use of these agents might enhance the efficacy of embolic protection devices. Methods and results: In the prospective, multicentre FilterWire EX Randomized Evaluation trial, 651 patients undergoing SVG stenting were randomized to either filter-based FilterWire EX or balloon occlusion/aspiration GuardWire embolic protection devices. IIb/IIIa inhibitor use was at the discretion of the investigator, with randomization stratified by intended use. Patients pre-selected for IIb/IIIa inhibitor use(n=345) had higher baseline risk, with increased 30-day major adverse cardiac events(MACE, 13.0 vs. 8.0%, P=0.03). GuardWire assigned patients treated with IIb/IIIa inhibitors had higher 30-day MACE compared with those not treated with IIb/IIIa inhibitors(16.0 vs. 6.3%, P=0.007). In contrast, MACE in high-risk FilterWire patients treated with IIb/IIIa inhibitors were similar to their lower risk, untreated counterparts(9.9 vs. 9.5%, P=0.89). Multivariable analysis detected a borderline significant(P=0.056) interaction for lower MACE between FilterWire and IIb/ IIIa inhibitor use. Adjustment by the propensity to use IIb/IIIa inhibitors resulted in a significant(P=0.023) interaction for lower MACE rates. IIb/IIIa inhibition in conjunction with FilterWire was associated with less abrupt closure, no reflow, or distal embolization. Conclusion: IIb/IIIa antagonists may improve procedural outcome during SVG stenting in high risk patients, utilizing filter-based embolic protection devices.
文摘目的观察不同血管分型的进展性缺血性脑卒中(PIS)的基线特征及应用替罗非班的临床效果。方法回顾性选取2020年3月—2022年3月湘潭市中心医院收治的PIS患者89例,根据治疗方法不同分为观察组42例和对照组47例。对照组患者予以常规治疗及阿司匹林100 mg联合氢氯吡格雷75 mg抗血小板聚集,观察组患者在对照组基础上加用替罗非班治疗,根据责任血管(小动脉闭塞型和大动脉粥样硬化型)进一步亚组分析,比较各组NIHSS评分、住院时间,随访90 d,比较各组mRS评分、焦虑、抑郁及胃肠道出血发生率。结果观察组与对照组及各亚组基线特征、入院时NIHSS评分、加重时NIHSS评分比较差异均无统计学意义(P>0.05);观察组治疗7 d后NIHSS评分低于对照组,ΔNIHSS评分及随访90 d mRS评分良好率高于对照组,住院时间短于对照组(P<0.05)。根据责任血管分型的亚组分析显示,在小动脉闭塞亚组中,观察亚组加重7 d后的NIHSS评分低于对照亚组,ΔNIHSS评分及随访90 d mRS评分良好率高于对照亚组,住院时间短于对照亚组(P<0.05);而在大动脉粥样硬化亚组中,2亚组患者基线特征、入院时NIHSS评分、加重时NIHSS评分、治疗7 d后NIHSS评分、ΔNIHSS评分、住院时间及随访90 d mRS评分良好率比较差异均无统计学意义(P>0.05)。随访90 d,观察组与对照组及各亚组焦虑、抑郁、胃肠道出血发生率比较差异均无统计学意义(P>0.05)。结论与口服抗血小板药物比较,替罗非班对不同责任血管导致的PIS疗效可能存在差异,替罗非班可显著改善小动脉闭塞型PIS的神经功能缺损,疗效确切,且安全性高,值得推广应用。
