目的：系统评价阿昔单抗冠状动脉内应用与静脉内应用在经皮冠状动脉介入（PCI）治疗中的疗效和安全性。方法计算机检索PubMed、EMBASE、OVID、CBM、CNKI、VIP ，检索时间均从建库至2013年9月30日，并手工检索最近1年国内已发表的有关论...目的：系统评价阿昔单抗冠状动脉内应用与静脉内应用在经皮冠状动脉介入（PCI）治疗中的疗效和安全性。方法计算机检索PubMed、EMBASE、OVID、CBM、CNKI、VIP ，检索时间均从建库至2013年9月30日，并手工检索最近1年国内已发表的有关论文，纳入冠状动脉内应用阿昔单抗与静脉内应用阿昔单抗比较在PCI治疗中应用的所有随机对照试验（RCTs），并同时追索纳入研究的参考文献。按照Cochrane系统评价方法，由两名评价者独立对纳入研究的质量进行评价和资料提取后，采用RevMan5．1软件进行Meta分析。结果共纳入8个RCT ，10篇文献，包括4150例进行PCI治疗的患者。Meta分析结果显示：（1）阿昔单抗负荷剂量常规静脉给药组与阿昔单抗负荷剂量冠状动脉给药组相比，主要不良心脏事件（MACE）发生率和病死率在两组之间差异无统计学意义（OR＝0．78，95％ CI 0．54～1．14，P＝0．20）、（OR＝0．56，95％ CI 0．24～1．30，P＝0．18）。（2）与阿昔单抗负荷剂量静脉给药相比，阿昔单抗负荷剂量冠状动脉给药的严重出血事件发生率差异无统计学意义（OR＝1．26，95％ CI 0.78～2．02，P＝0．35）。结论与常规静脉给药相比，阿昔单抗负荷剂量冠状动脉内给药临床疗效相当，且不增加出血事件发生率。展开更多
目的：比较冠状动脉内（IC）应用阿昔单抗与静脉应用（IV）阿昔单抗治疗ST段抬高型心肌梗死（STE-MI）的疗效和安全性。方法：计算机检索PubMed、Coehrane Central Register of Controlled Trials、中国生物医学文献数据库、CNKI全文数...目的：比较冠状动脉内（IC）应用阿昔单抗与静脉应用（IV）阿昔单抗治疗ST段抬高型心肌梗死（STE-MI）的疗效和安全性。方法：计算机检索PubMed、Coehrane Central Register of Controlled Trials、中国生物医学文献数据库、CNKI全文数据库，收集1993年1月至2014年6月公开发表的有关Ic阿昔单抗和IV阿昔单抗疗效比较的随机对照试验（RCTs），手检可获的参考文献、会议摘要及相关网站资料。对符合要求的RCTs进行资料提取，并采用RevMan5．0软件进行Meta分析。结果：共纳入7项RCTs，Meta分析显示：IC阿昔单抗组再发心肌梗死发生率显著低于IV阿昔单抗组（OR=0．61，95％CI：0．40～0．92，P=0．02）；IC阿昔单抗组与IV阿昔单抗组之间全因死亡率（OR=0．85，95％CI；0．59～1．23，P=0．39）、靶血管再血管化率（OR=0．66，95％CI：0．40～1．09，P=0．10）、大出血发生率（OR=1．00，95％CI：0．68～1．47，P=0．99）均无显著差异。结论：冠脉内应用阿昔单抗能更显著降低sT抬高型心肌梗死患者再发心肌梗死发生察，初步显示了冠脉内应用阿昔单抗疗效的优越性。展开更多
Platelet-monocyte aggregates and other markers of platelet activation were investigated before and after percutaneous coronary intervention(PCI) with abciximab therapy. The study sought to assess the relationship betw...Platelet-monocyte aggregates and other markers of platelet activation were investigated before and after percutaneous coronary intervention(PCI) with abciximab therapy. The study sought to assess the relationship between the level of platelet-monocyte aggregation and increases in cardiac troponin I post coronary intervention. Methods: Blood samples were collected from 40 patients before PCI and 10 min after abciximab administration. These were tested for platelet activation markers by flow cytometry. Cardiac troponin I levels were assayed at baseline and at 24 h post PCI. Results: Compared to healthy controls, patients with coronary artery disease had elevated markers of platelet activation including platelet-monocyte aggregates, P-selectin and PAC- 1(a marker specific for activated glycoprotein IIb/IIIa) prior to PCI. Increased levels of platelet-monocyte aggregates before PCI were associated with increased expression of P-selectin on the platelet surface. Abciximab therapy reduced platelet-monocyte aggregate levels but had no effect on P-selectin expression. The high levels of expression of activated glycoprotein IIb/IIIa(PAC-1) on platelets prior to PCI was reduced with abciximab therapy. Patients with higher levels of platelet-monocyte aggregates prior to PCI were more likely to develop an elevation of cardiac troponin I during the 24 h after PCI. Conclusions: Increased levels of platelet-monocyte aggregates may predict patients at risk for troponin elevation following PCI and identify those most likely to benefit from abciximab.展开更多
Background: The TARGET study has been criticised for suboptimal platelet inhib ition with tirofiban. We aimed to compare a high-dose bolus regimen of tirofiba n(hd-tirofiban) to standard dose of abciximab for patients...Background: The TARGET study has been criticised for suboptimal platelet inhib ition with tirofiban. We aimed to compare a high-dose bolus regimen of tirofiba n(hd-tirofiban) to standard dose of abciximab for patients undergoing percutane ous coronary intervention(PCI). Methods: We assessed consecutive patients who re ceived either hd-tirofiban(25 mcg/kg bolus followed by 0.15 mcg/kg/min infusion for 18 h) or standard dose abciximab. In-hospital and 6-month outcomes were o btained in all cases. Results: Over an 18-month period, 109 patients who receiv ed hd-tirofiban were compared with 110 patients who received abciximab. Both hd -tirofiban and abciximab groups had acute coronary syndromes in 86%and 80%and diabetes in 10%and 13%respectively. Most patients had coronary stent implanta tion(96%vs. 98%). Thrombocytopenia(platelet count< 100,000) developed in 0.9% of patients receiving hd-tirofiban and 2%of patients receiving abciximab(p=0.5 66). Bleeding requiring transfusion occurred in 7.3%and 3%of patients respecti vely(p=0.118). Peri-procedural troponin rise was 0.9%in patients receiving hd -tirofiban and 5.5%in patients receiving abciximab(p=0.07). MACE(Myocardial in farction, Stroke, Revascularisation and Death) at 6 months was 23%in the hd-ti rofiban group and 20%in the abciximab group(p=0.711). The pharmaceutical costs were AUD 322 for hd-tirofiban(one ampoule) and AUD 1350 for abciximab(3 ampoule s). Conclusion: There was a small increase in bleeding requiring transfusion and a lower rate of peri-procedural troponin rise in the hd-tirofiban group howev er, the overall 6-month MACE rates were similar in both groups. There was a con siderable cost-saving with the use of hd-tirofiban. A prospective randomized t rial of hd-tirofiban vs. abciximab is warranted.展开更多
《新英格兰医学杂志》（New England Journal of Medicine）在2011年11月24日发表了ISAR-REACT4研究的结果。表明在接受经皮冠状动脉介入治疗（PCI）的非ST段抬高心肌梗死（NSTEMI）患者中,与比伐卢定相比,阿昔单抗＋普通肝素未能降低...《新英格兰医学杂志》（New England Journal of Medicine）在2011年11月24日发表了ISAR-REACT4研究的结果。表明在接受经皮冠状动脉介入治疗（PCI）的非ST段抬高心肌梗死（NSTEMI）患者中,与比伐卢定相比,阿昔单抗＋普通肝素未能降低主要终点的发生率,却增加了出血风险（N Engl J Med,2011,365：1980-1989）。展开更多
文摘目的：系统评价阿昔单抗冠状动脉内应用与静脉内应用在经皮冠状动脉介入（PCI）治疗中的疗效和安全性。方法计算机检索PubMed、EMBASE、OVID、CBM、CNKI、VIP ，检索时间均从建库至2013年9月30日，并手工检索最近1年国内已发表的有关论文，纳入冠状动脉内应用阿昔单抗与静脉内应用阿昔单抗比较在PCI治疗中应用的所有随机对照试验（RCTs），并同时追索纳入研究的参考文献。按照Cochrane系统评价方法，由两名评价者独立对纳入研究的质量进行评价和资料提取后，采用RevMan5．1软件进行Meta分析。结果共纳入8个RCT ，10篇文献，包括4150例进行PCI治疗的患者。Meta分析结果显示：（1）阿昔单抗负荷剂量常规静脉给药组与阿昔单抗负荷剂量冠状动脉给药组相比，主要不良心脏事件（MACE）发生率和病死率在两组之间差异无统计学意义（OR＝0．78，95％ CI 0．54～1．14，P＝0．20）、（OR＝0．56，95％ CI 0．24～1．30，P＝0．18）。（2）与阿昔单抗负荷剂量静脉给药相比，阿昔单抗负荷剂量冠状动脉给药的严重出血事件发生率差异无统计学意义（OR＝1．26，95％ CI 0.78～2．02，P＝0．35）。结论与常规静脉给药相比，阿昔单抗负荷剂量冠状动脉内给药临床疗效相当，且不增加出血事件发生率。
文摘目的：比较冠状动脉内（IC）应用阿昔单抗与静脉应用（IV）阿昔单抗治疗ST段抬高型心肌梗死（STE-MI）的疗效和安全性。方法：计算机检索PubMed、Coehrane Central Register of Controlled Trials、中国生物医学文献数据库、CNKI全文数据库，收集1993年1月至2014年6月公开发表的有关Ic阿昔单抗和IV阿昔单抗疗效比较的随机对照试验（RCTs），手检可获的参考文献、会议摘要及相关网站资料。对符合要求的RCTs进行资料提取，并采用RevMan5．0软件进行Meta分析。结果：共纳入7项RCTs，Meta分析显示：IC阿昔单抗组再发心肌梗死发生率显著低于IV阿昔单抗组（OR=0．61，95％CI：0．40～0．92，P=0．02）；IC阿昔单抗组与IV阿昔单抗组之间全因死亡率（OR=0．85，95％CI；0．59～1．23，P=0．39）、靶血管再血管化率（OR=0．66，95％CI：0．40～1．09，P=0．10）、大出血发生率（OR=1．00，95％CI：0．68～1．47，P=0．99）均无显著差异。结论：冠脉内应用阿昔单抗能更显著降低sT抬高型心肌梗死患者再发心肌梗死发生察，初步显示了冠脉内应用阿昔单抗疗效的优越性。
文摘Platelet-monocyte aggregates and other markers of platelet activation were investigated before and after percutaneous coronary intervention(PCI) with abciximab therapy. The study sought to assess the relationship between the level of platelet-monocyte aggregation and increases in cardiac troponin I post coronary intervention. Methods: Blood samples were collected from 40 patients before PCI and 10 min after abciximab administration. These were tested for platelet activation markers by flow cytometry. Cardiac troponin I levels were assayed at baseline and at 24 h post PCI. Results: Compared to healthy controls, patients with coronary artery disease had elevated markers of platelet activation including platelet-monocyte aggregates, P-selectin and PAC- 1(a marker specific for activated glycoprotein IIb/IIIa) prior to PCI. Increased levels of platelet-monocyte aggregates before PCI were associated with increased expression of P-selectin on the platelet surface. Abciximab therapy reduced platelet-monocyte aggregate levels but had no effect on P-selectin expression. The high levels of expression of activated glycoprotein IIb/IIIa(PAC-1) on platelets prior to PCI was reduced with abciximab therapy. Patients with higher levels of platelet-monocyte aggregates prior to PCI were more likely to develop an elevation of cardiac troponin I during the 24 h after PCI. Conclusions: Increased levels of platelet-monocyte aggregates may predict patients at risk for troponin elevation following PCI and identify those most likely to benefit from abciximab.
文摘Background: The TARGET study has been criticised for suboptimal platelet inhib ition with tirofiban. We aimed to compare a high-dose bolus regimen of tirofiba n(hd-tirofiban) to standard dose of abciximab for patients undergoing percutane ous coronary intervention(PCI). Methods: We assessed consecutive patients who re ceived either hd-tirofiban(25 mcg/kg bolus followed by 0.15 mcg/kg/min infusion for 18 h) or standard dose abciximab. In-hospital and 6-month outcomes were o btained in all cases. Results: Over an 18-month period, 109 patients who receiv ed hd-tirofiban were compared with 110 patients who received abciximab. Both hd -tirofiban and abciximab groups had acute coronary syndromes in 86%and 80%and diabetes in 10%and 13%respectively. Most patients had coronary stent implanta tion(96%vs. 98%). Thrombocytopenia(platelet count< 100,000) developed in 0.9% of patients receiving hd-tirofiban and 2%of patients receiving abciximab(p=0.5 66). Bleeding requiring transfusion occurred in 7.3%and 3%of patients respecti vely(p=0.118). Peri-procedural troponin rise was 0.9%in patients receiving hd -tirofiban and 5.5%in patients receiving abciximab(p=0.07). MACE(Myocardial in farction, Stroke, Revascularisation and Death) at 6 months was 23%in the hd-ti rofiban group and 20%in the abciximab group(p=0.711). The pharmaceutical costs were AUD 322 for hd-tirofiban(one ampoule) and AUD 1350 for abciximab(3 ampoule s). Conclusion: There was a small increase in bleeding requiring transfusion and a lower rate of peri-procedural troponin rise in the hd-tirofiban group howev er, the overall 6-month MACE rates were similar in both groups. There was a con siderable cost-saving with the use of hd-tirofiban. A prospective randomized t rial of hd-tirofiban vs. abciximab is warranted.
文摘《新英格兰医学杂志》（New England Journal of Medicine）在2011年11月24日发表了ISAR-REACT4研究的结果。表明在接受经皮冠状动脉介入治疗（PCI）的非ST段抬高心肌梗死（NSTEMI）患者中,与比伐卢定相比,阿昔单抗＋普通肝素未能降低主要终点的发生率,却增加了出血风险（N Engl J Med,2011,365：1980-1989）。
