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首页> 外文期刊>The American Journal of Cardiology >Intracoronary compared to intravenous Abciximab and high-dose bolus compared to standard dose in patients with ST-segment elevation myocardial infarction undergoing transradial primary percutaneous coronary intervention: a two-by-two factorial placebo-controlled randomized study.
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Intracoronary compared to intravenous Abciximab and high-dose bolus compared to standard dose in patients with ST-segment elevation myocardial infarction undergoing transradial primary percutaneous coronary intervention: a two-by-two factorial placebo-controlled randomized study.

机译：ST段抬高型心肌梗死患者行经radi动脉原位经皮冠状动脉介入治疗的冠状动脉内比较静脉注射阿昔单抗和大剂量推注比较标准剂量：一项两两两的安慰剂对照随机研究。

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Platelet aggregation inhibition (PAI) of > or =95% has been associated with improved outcomes after percutaneous coronary intervention (PCI) and glycoprotein IIb/IIIa inhibitor treatment. A greater thrombotic burden in acute ST-segment elevation myocardial infarction (STEMI) might require higher doses and/or intracoronary delivery of glycoprotein IIb/IIIa inhibitors to achieve optimal PAI. Using a 2 x 2 factorial placebo-controlled design, 105 patients with STEMI who had been referred for primary PCI within 6 hours of symptom onset were randomized to intracoronary (IC) or intravenous (IV) delivery of an abciximab bolus at a standard dose (0.25 mg/kg) or high dose (> or =0.30 mg/kg) of abciximab. The primary end point was PAI measured at 10 minutes after the bolus of abciximab. Secondary end points included the acute and 6-month outcomes using angiographic parameters, cardiac biomarkers, cardiovascular magnetic resonance imaging, and clinical end points. At 10 minutes after the bolus, the proportion of patients with > or =95% PAI was not different between the IC and IV groups (53% vs 54%, p = 1.00) nor between the high-dose and standard-dose bolus groups (56% vs 51%, p = 0.70). Acutely, the angiographic myocardial blush grades, peak release of cardiac biomarkers, necrosis size, myocardial perfusion, and no reflow as assessed by magnetic resonance imaging, and clinical end points were similar between the groups and did not suggest a benefit for IC compared to IV or high-dose versus standard-dose bolus of abciximab. No increase occurred in bleeding complications with the high-dose bolus or IC delivery. The clinical, angiographic and cardiac magnetic resonance imaging outcomes at 6 and 12 months were similar between the 4 groups. In conclusion, in patients with STEMI presenting with symptom onset <6 hours and undergoing transradial primary PCI, PAI remained suboptimal, despite a higher dose bolus of abciximab. A higher dose bolus or IC delivery of abciximab bolus was not associated with improved acute or late results compared to the standard IV dosing and administration.
机译：≥95％的血小板凝集抑制（PAI）与经皮冠状动脉介入治疗（PCI）和糖蛋白IIb / IIIa抑制剂治疗后的预后改善相关。急性ST段抬高型心肌梗塞（STEMI）中更大的血栓形成负担可能需要更高剂量和/或冠状动脉内糖蛋白IIb / IIIa抑制剂递送，以实现最佳PAI。使用2 x 2阶乘安慰剂对照设计，将105例在症状发作6小时内转诊为原发PCI的STEMI患者随机分配至标准剂量的abciximab推注的冠状动脉内（IC）或静脉内（IV）给药（ 0.25 mg / kg）或高剂量（>或= 0.30 mg / kg）的阿昔单抗。主要终点是推注阿昔单抗后10分钟的PAI。次要终点包括使用血管造影参数，心脏生物标志物，心血管磁共振成像和临床终点的急性和6个月预后。推注后10分钟，IC组和IV组之间PAI≥95％的患者比例无差异（53％vs 54％，p = 1.00），大剂量和标准剂量推注组之间无差异（56％vs 51％，p = 0.70）。急性地，通过磁共振成像评估，血管造影心肌腮红等级，心脏生物标志物的峰值释放，坏死面积，心肌灌注和无复流，并且各组之间的临床终点相似，因此与IV相比，IC无益处还是阿昔单抗的高剂量与标准剂量推注。大剂量推注或IC递送的出血并发症没有增加。 4组在6和12个月时的临床，血管造影和心脏磁共振成像结果相似。结论：在症状发作时间少于6小时且接受trans动脉原发性PCI的STEMI患者中，尽管阿昔单抗的剂量更高，但PAI仍不理想。与标准IV剂量和给药相比，较高剂量的推注或abciximab推注的IC递送与改善的急性或晚期结果无关。

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