Context: Glycoprotein IIb/IIIa (Gp IIb/IIIa) inhibitors improve myocard ial rep erfusion and clinical outcomes of patients undergoing primary percutaneous coron ary intervention (PCI), but optimal timing of administra...Context: Glycoprotein IIb/IIIa (Gp IIb/IIIa) inhibitors improve myocard ial rep erfusion and clinical outcomes of patients undergoing primary percutaneous coron ary intervention (PCI), but optimal timing of administration remains unclear. No systematic reviews have comprehensively examined the effects of early vs delaye d administration of these agents. Objective: To perform a meta-analysis of ra nd omized trials of early (prior to transfer to the catheterization laboratory) vs late (at the time of PCI) intravenous administration of Gp IIb/IIIa inhibitors i n acute ST-segment elevation myocardial infarction (STEMI). Data Sources: MEDLI NE and the Cochrane Controlled Trials Register search of the literature over the past 10 years; papers presented at major cardiac conferences; consultation with national and international colleagues as well as Gp IIb/IIIa inhibitor drug man ufacturers; and text and journal article bibliographies. Study Selection and Dat a Extraction: We examined trials of randomized comparisons between early adminis tration at the point of initial contact (emergency department or ambulance) and late administration (catheterization laboratory) of Gp IIb/IIIa inhibitors in ST EMI. Outcome data had to be available on both culprit artery patency evaluated b y Thrombolysis in Myocardial Infarction (TIMI) flow grades on admission and mort ality. Two authors independently reviewed abstracts or complete articles. Six st udies met inclusion criteria. Independent data extraction was performed by 2 rev iewers and confirmed by consensus. Data Synthesis: The 6 trials enrolled 931 STEMI patients treated with abciximab (3 trials) or tirofiban (3 trials) in combination with primary P CI. TIMI grade 2 or 3 flow (41.7%<<194/465 vs 29.8%<<139/466>>) as well as TIMI g rade 3 flow (20.3%<<84/ 413>> vs 12.2%<<51/418>>) were significantly more frequent in the early group compared with the late group (odds ratio <<OR>>, 1.69; 95%con fidence interval <<CI>>, 1.28-2.22; P< .001; and OR, 1.85; 95%CI, 1.26-2.71; P< .001, respectively). The early administration of Gp IIb/IIIa inhibitors was ass ociated with a 28%reduction of mortality from 4.7%to 3.4%, which was not sign ificant but consistent with similar trends for reinfarction and the composite is chemic end point. Conclusions: In a meta-analysis of 6 randomized trials, early administration of Gp IIb/IIIa inhibitors in STEMI appeared to improve coronary patency with favorable trends for clinical outcomes. These findings are supporti ve of a strategy of facilitated PCI. Further evaluations in adequately powered l arge trials are awaited to confirm the clinical benefit of this strategy.展开更多
Objective: to report the application of GPIIb/IIIa antagonist (Integrilin) in peri percutaneous transluminal catheter angioplasty and stent implantation in Chinese. Method: Twenty one patients who underwent percutan...Objective: to report the application of GPIIb/IIIa antagonist (Integrilin) in peri percutaneous transluminal catheter angioplasty and stent implantation in Chinese. Method: Twenty one patients who underwent percutaneous transluminal catheter angioplasty(PTCA) and stent implantation were included. After arterial puncture, integrilin was injected at dose of 180ug/kg, and then maintained at 2μg/kg·min for 18 hours. Asprine, plavix(clopidogrel) and heparin were used at the same time. ACT, PT, KPTT and blood routine were routinely monitored. Results: All sheaths were drawn out 2 to 4 hours after the procedure.. There was no severe complication such as hematoma, acute and subacute thrombosis in coronary artery, or thrombocytopenia. ACT returned to less than 150 seconds in 2 hours in 15 patients; in 4 hours in 6 patients. There was no significant difference between the pre and post procedure value of PT and platelet count. KPTT was significantly higher than pre procedure value at 2 hours after the procedure .No recurrence of angina pectoris was observed in the first nine patients within one year follow up, and no restenosis occurred in stents in the five patients who had coronary angiography one year later. Conclusion: Application of GPIIb/IIIa receptor antagonist (Integrilin) in peri percutaneous transluminal catheter angioplasty and stent implantation in combination with aspirin and plavix could significantly reduce the dosage and duration of heparin with benefit of shortening the indwelling time of sheaths, but did not increase risk of bleeding or lead to thrombosis in stent.展开更多
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
文摘Context: Glycoprotein IIb/IIIa (Gp IIb/IIIa) inhibitors improve myocard ial rep erfusion and clinical outcomes of patients undergoing primary percutaneous coron ary intervention (PCI), but optimal timing of administration remains unclear. No systematic reviews have comprehensively examined the effects of early vs delaye d administration of these agents. Objective: To perform a meta-analysis of ra nd omized trials of early (prior to transfer to the catheterization laboratory) vs late (at the time of PCI) intravenous administration of Gp IIb/IIIa inhibitors i n acute ST-segment elevation myocardial infarction (STEMI). Data Sources: MEDLI NE and the Cochrane Controlled Trials Register search of the literature over the past 10 years; papers presented at major cardiac conferences; consultation with national and international colleagues as well as Gp IIb/IIIa inhibitor drug man ufacturers; and text and journal article bibliographies. Study Selection and Dat a Extraction: We examined trials of randomized comparisons between early adminis tration at the point of initial contact (emergency department or ambulance) and late administration (catheterization laboratory) of Gp IIb/IIIa inhibitors in ST EMI. Outcome data had to be available on both culprit artery patency evaluated b y Thrombolysis in Myocardial Infarction (TIMI) flow grades on admission and mort ality. Two authors independently reviewed abstracts or complete articles. Six st udies met inclusion criteria. Independent data extraction was performed by 2 rev iewers and confirmed by consensus. Data Synthesis: The 6 trials enrolled 931 STEMI patients treated with abciximab (3 trials) or tirofiban (3 trials) in combination with primary P CI. TIMI grade 2 or 3 flow (41.7%<<194/465 vs 29.8%<<139/466>>) as well as TIMI g rade 3 flow (20.3%<<84/ 413>> vs 12.2%<<51/418>>) were significantly more frequent in the early group compared with the late group (odds ratio <<OR>>, 1.69; 95%con fidence interval <<CI>>, 1.28-2.22; P< .001; and OR, 1.85; 95%CI, 1.26-2.71; P< .001, respectively). The early administration of Gp IIb/IIIa inhibitors was ass ociated with a 28%reduction of mortality from 4.7%to 3.4%, which was not sign ificant but consistent with similar trends for reinfarction and the composite is chemic end point. Conclusions: In a meta-analysis of 6 randomized trials, early administration of Gp IIb/IIIa inhibitors in STEMI appeared to improve coronary patency with favorable trends for clinical outcomes. These findings are supporti ve of a strategy of facilitated PCI. Further evaluations in adequately powered l arge trials are awaited to confirm the clinical benefit of this strategy.
文摘Objective: to report the application of GPIIb/IIIa antagonist (Integrilin) in peri percutaneous transluminal catheter angioplasty and stent implantation in Chinese. Method: Twenty one patients who underwent percutaneous transluminal catheter angioplasty(PTCA) and stent implantation were included. After arterial puncture, integrilin was injected at dose of 180ug/kg, and then maintained at 2μg/kg·min for 18 hours. Asprine, plavix(clopidogrel) and heparin were used at the same time. ACT, PT, KPTT and blood routine were routinely monitored. Results: All sheaths were drawn out 2 to 4 hours after the procedure.. There was no severe complication such as hematoma, acute and subacute thrombosis in coronary artery, or thrombocytopenia. ACT returned to less than 150 seconds in 2 hours in 15 patients; in 4 hours in 6 patients. There was no significant difference between the pre and post procedure value of PT and platelet count. KPTT was significantly higher than pre procedure value at 2 hours after the procedure .No recurrence of angina pectoris was observed in the first nine patients within one year follow up, and no restenosis occurred in stents in the five patients who had coronary angiography one year later. Conclusion: Application of GPIIb/IIIa receptor antagonist (Integrilin) in peri percutaneous transluminal catheter angioplasty and stent implantation in combination with aspirin and plavix could significantly reduce the dosage and duration of heparin with benefit of shortening the indwelling time of sheaths, but did not increase risk of bleeding or lead to thrombosis in stent.
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。
