Effect of glycoprotein IIb/IIIa receptor blockade with abciximab on clinical and angiographic restenosis rate after the placement of coronary stents following acute myocardial infarction
Effect of glycoprotein IIb/IIIa receptor blockade with abciximab on clinical and angiographic restenosis rate after the placement of coronary stents following acute myocardial infarction
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DOI：
10.1016/s0735-1097(99)00635-x
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发表时间：
2000-03-15
影响因子：
24
通讯作者：
Schömig, A
中科院分区：
文献类型：
--
作者：
Neumann, FJ;Kastrati, A;Schömig, A
目的：在冠状动脉内支架植入术和抗血栓治疗方案-2试验（ISAR-2）中，我们试图研究阿昔单抗对急性心肌梗死（AMI）后支架植入术后血管造影和临床再狭窄的影响。我们还打算评估阿昔单抗在这种情况下对临床结果的影响。背景：目前尚不清楚阿昔单抗是否能减少支架植入术后新生内膜的形成。这种作用在含血栓的病变中可能特别突出。方法AMI发病后48小时内接受支架植入术的患者随机分为标准剂量肝素组和阿昔单抗加减剂量肝素组。在401名随机分配的患者中，366名没有30天不良事件的患者有资格进行6个月的血管造影随访。80%的患者进行了血管造影。结果30 d时，阿昔单抗组患者达到死亡、再梗死和靶区血运重建（TLR）复合临床终点的比例为5.0%，对照组为10.5% （p = 0.038）。一年后，阿昔单抗复合临床终点的绝对降低率仍为5.7%，但已失去统计学意义。我们的主要终点，晚期管腔损失，阿昔单抗组为1.26 +/- 0.85 mm，标准肝素组为1.21 +/- 0.74 mm (p = 0.61)，二元血管造影再狭窄率分别为31.1%和30.6% （p = 0.92）。结论：在AMI后接受支架植入的患者中，阿昔单抗通过显著降低30天内主要不良心脏事件的发生率发挥了有益的作用。在一年的随访中，TLR的降低没有带来额外的益处，阿昔单抗也没有减少血管造影再狭窄。(C) 2000年由美国心脏病学会发布。
OBJECTIVES In the Intracoronary Stenting and Antithrombotic Regimen-2 trial (ISAR-2), we sought to investigate the effect of abciximab on angiographic and clinical restenosis after stenting following acute myocardial infarction (AMI). We also intended to assess the impact of abciximab on clinical outcome in this setting.BACKGROUND It is unclear whether abciximab reduces neointima formation after stenting. Such an effect may be particularly prominent in thrombus-containing lesions.METHODS Patients undergoing stenting within 48 h after onset of AMI were randomly assigned to receive either standard-dose heparin or abciximab plus reduced-dose heparin. Of 401 patients randomized, 366 without 30-day adverse events were eligible for six-month angiographic follow-up. Scheduled angiography was performed in 80% of these patients.RESULTS By 30 days, the composite clinical end point of death, reinfarction, and target lesion revascularization (TLR) was reached in 5.0% of the abciximab group and in 10.5% of the control group (p = 0.038). At one year, absolute reduction in the composite clinical end point by abciximab was still 5.7% but had lost its statistical significance. Our primary end point, late lumen loss, was 1.26 +/- 0.85 mm with abciximab and 1.21 +/- 0.74 mm with standard heparin (p = 0.61), and binary angiographic restenosis rates were 31.1% and 30.6%, respectively (p = 0.92).CONCLUSIONS In patients undergoing stenting following AMI, abciximab exerted beneficial effects by substantially reducing the 30-day rate of major adverse cardiac events. During one-year follow-up, there was no additional benefit from a reduction in TLR nor did abciximab reduce angiographic restenosis. (C) 2000 by the American College of Cardiology.