冠脉注射血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂用于急性冠脉综合征经皮介入治疗的Meta分析_《中国循证医学杂志》

作者：

尹晴 ^1,2 , 张志刚 ² , 马亚平 ³ ,  李斌飞 ²

1. 中山大学附属第一医院（广州 510080）；2. 中山市人民医院麻醉科（中山 528403）；3. 深圳翰宇药业股份有限公司（深圳 518057）;

关键词：

血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂急性冠脉综合征经皮介入治疗冠脉静脉系统评价 Meta分析随机对照试验

DOI：

10.7507/1672-2531.20130189

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　系统评价血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂（GPIs）冠脉内应用与静脉内应用在急性冠脉综合征（ACS）经皮介入治疗（PCI）中的疗效和安全性。
方法　计算机检索PubMed、EMbase、The Cochrane Library（2012年第9期）、Ovid、CBM、CNKI和VIP，收集冠脉内应用GPIs与静脉内应用GPIs比较治疗ACS的随机对照试验（RCT），检索时限均从建库至2012年9月30日。同时手工检索最近1年国内已发表的有关文献，并追溯纳入研究的参考文献。由2位评价者根据纳入与排除标准独立筛选文献、提取资料和评价纳入研究的方法学质量，而后采用RevMan 5.1软件进行Meta分析。
结果　最终纳入10个RCT，共3 553例ACS患者。Meta分析结果显示：① 与初始剂量常规静脉给药相比，GPIs初始剂量冠脉给药能降低给药后主要不良心脏事件发生率［OR=0.54，95%CI（0.34，0.85），P=0.008］、再次心肌梗死发生率［OR=0.62，95%CI（0.39，0.97），P=0.04］、血运重建发生率［OR=0.59，95%CI（0.36，0.97），P=0.04］及心衰发生率［OR=0.52，95%CI（0.32，0.84），P=0.008］，但两组病死率差异无统计学意义［OR=0.81，95%CI（0.58，1.14），P=0.23］。② 与初始剂量静脉给药相比，GPIs初始剂量冠脉给药的轻微出血及严重出血发生率均无明显差异［轻微出血：OR=0.94，95%CI（0.75，1.19），P=0.63；严重出血：OR=1.18，95%CI（0.76，1.84），P=0.47］。
结论　与常规静脉给药相比，GPIs初始剂量冠脉给药能更好地改善接受PCI治疗的ACS患者的临床预后，且不增加出血发生率。

引用本文： 尹晴,张志刚,马亚平,李斌飞. 冠脉注射血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂用于急性冠脉综合征经皮介入治疗的Meta分析. 中国循证医学杂志, 2013, 13(9): 1102-1109. doi: 10.7507/1672-2531.20130189 复制

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2.	ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). G Ital Cardiol (Rome), 2012, 13(3): 171-228.
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6.	Mehilli J, Kastrati A, Schulz S, et al. Abciximab in patients with acute ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention after clopidogrel loading: a randomized double-blind trial. Circulation, 2009, 119(14): 1933-1940.
7.	Nakagawa Y, Nobuyoshi M, Yamaguchi T, et al. Efficacy of abciximab for patients undergoing balloon angioplasty: data from Japanese evaluation of c7E3 Fab for elective and primary PCI organization in randomized trial (JEPPORT). Circ J, 2009, 73(1): 145-151.
8.	Ndrepepa G, Kastrati A, Mehilli J, et al. One-year clinical outcomes with abciximab vs. placebo in patients with non-ST-segment elevation acute coronary syndromes undergoing percutaneous coronary intervention after pre-treatment with clopidogrel: results of the ISAR-REACT 2 randomized trial. Eur Heart J, 2008, 29(4): 455-461.
9.	Iversen A, Abildgaard U, Galloe A, et al. Intracoronary compared to intravenous bolus abciximab during primary percutaneous coronary intervention in ST-segment Elevation Myocardial Infarction (STEMI) patients reduces 30-day mortality and target vessel revascularization: a randomized trial. J Interv Cardiol, 2011, 24(2): 105-111.
10.	Eitel I, Friedenberger J, Fuernau G, et al. Intracoronary versus intravenous bolus abciximab application in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: 6-month effects on infarct size and left ventricular function. The randomised Leipzig Immediate PercutaneouS Coronary Intervention Abciximab i.v. versus i.c. in ST-Elevation Myocardial Infarction Trial (LIPSIAbciximab-STEMI). Clin Res Cardiol, 2011, 100(5): 425-432.
11.	Thiele H, Wohrle J, Hambrecht R, et al. Intracoronary versus intravenous bolus abciximab during primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction: a randomised trial. Lancet, 2012, 379(9819): 923-931.
12.	Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1[updated March 2011].The Cochrane Collaboration, 2008. Available from:www.cochrane-handbook.org.
13.	Thiele H, Schindler K, Friedenberger J, et al. Intracoronary compared with intravenous bolus abciximab application in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: the randomized Leipzig immediate percutaneous coronary intervention abciximab IV versus IC in ST-elevation myocardial infarction trial. Circulation, 2008, 118(1): 49-57.
14.	Gu YL, Kampinga MA, Wieringa WG, et al. Intracoronary versus intravenous administration of abciximab in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention with thrombus aspiration: the comparison of intracoronary versus intravenous abciximab administration during emergency reperfusion of ST-segment elevation myocardial infarction (CICERO) trial. Circulation, 2010, 122(25): 2709-2717.
15.	Dominguez-Rodriguez A, Abreu-Gonzalez P, Avanzas P, et al. Intracoronary versus intravenous abciximab administration in patients with ST-elevation myocardial infarction undergoing thrombus aspiration during primary percutaneous coronary intervention--effects on soluble CD40 ligand concentrations. Atherosclerosis, 2009, 206(2): 523-527.
16.	Iversen A Z, Galatius S, Abildgaard U, et al. Intracoronary compared to intravenous abciximab in patients with ST segment elevation myocardial infarction treated with primary percutaneous coronary intervention reduces mortality, target vessel revascularization and reinfarction after 1 year. Cardiology, 2011, 120(1): 43-49.
17.	Galache OJ, Sanchez-Rubio J, Calvo I, et al. Does intracoronary abciximab improve the outcome of percutaneous coronary interventions? A randomized controlled trial. Rev Esp Cardiol, 2006, 59(6): 567-574.
18.	Dave RM. Improving outcome of STEMI PCI: Preliminary Results of Crystal AMI trial. [2011-05-28]. Available from: http://www. clinicaltriairesults. org/slides/CRYSTAL_slid-es. PPT.
19.	Wu TG, Zhao Q, Huang WG, et al. Effect of intracoronary tirofiban in patients undergoing percutaneous coronary intervention for acute coronary syndrome. Circ J, 2008, 72(10): 1605-1609.
20.	杨新春, 张大鹏, 王乐丰, 等. 冠状动脉内应用国产替罗非班对急性ST段抬高心肌梗死急诊介入治疗后心肌灌注和临床预后的影响. 中华心血管病杂志, 2007, 35(6): 517-522.
21.	Deibele AJ, Jennings LK, Tcheng JE, et al. Intracoronary eptifibatide bolus administration during percutaneous coronary revascularization for acute coronary syndromes with evaluation of platelet glycoprotein IIb/IIIa receptor occupancy and platelet function: the Intracoronary Eptifibatide (ICE) Trial. Circulation, 2010, 121(6): 784-791.
22.	Schneider DJ. Anti-platelet therapy: glycoprotein IIb-IIIa antagonists. Br J Clin Pharmacol, 2011, 72(4): 672-682.
23.	Navarese EP, Kozinski M, Obonska K, et al. Clinical efficacy and safety of intracoronary vs. intravenous abciximab administration in STEMI patients undergoing primary percutaneous coronary intervention: a meta-analysis of randomized trials. Platelets, 2012, 23(4): 274-281.
24.	Ronner E, Boersma E, Akkerhuis KM, et al. Patients with acute coronary syndromes without persistent ST elevation undergoing percutaneous coronary intervention benefit most from early intervention with protection by a glycoprotein Ⅱb/Ⅲa receptor blocker. Eur Heart J, 2002, 23(3): 239-246.
25.	Friedland S, Eisenberg MJ, Shimony A. Meta-analysis of randomized controlled trials of intracoronary versus intravenous administration of glycoprotein IIb/IIIa inhibitors during percutaneous coronary intervention for acute coronary syndrome. Am J Cardiol, 2011, 108(9): 1244-1251.

1. Altay H, Pehlivanoglu S. Editorial: Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: What has changed in the new European Society of Cardiology guideline? Turk Kardiyol Dern Ars, 2012, 40(1): 1-8.
2. ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). G Ital Cardiol (Rome), 2012, 13(3): 171-228.
3. Fernandez-Ortiz A, Pan M, Alfonso F, et al. Comments on the ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. A report of the Task Force of the Clinical Practice Guidelines Committee of the Spanish Society of Cardiology. Rev Esp Cardiol, 2012, 65(2): 125-130.
4. Hamm CW, Bassand JP, Agewall S, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J, 2011, 32(23): 2999-3054.
5. Muller C. New ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Swiss Med Wkly, 2012, 142: w13514.
6. Mehilli J, Kastrati A, Schulz S, et al. Abciximab in patients with acute ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention after clopidogrel loading: a randomized double-blind trial. Circulation, 2009, 119(14): 1933-1940.
7. Nakagawa Y, Nobuyoshi M, Yamaguchi T, et al. Efficacy of abciximab for patients undergoing balloon angioplasty: data from Japanese evaluation of c7E3 Fab for elective and primary PCI organization in randomized trial (JEPPORT). Circ J, 2009, 73(1): 145-151.
8. Ndrepepa G, Kastrati A, Mehilli J, et al. One-year clinical outcomes with abciximab vs. placebo in patients with non-ST-segment elevation acute coronary syndromes undergoing percutaneous coronary intervention after pre-treatment with clopidogrel: results of the ISAR-REACT 2 randomized trial. Eur Heart J, 2008, 29(4): 455-461.
9. Iversen A, Abildgaard U, Galloe A, et al. Intracoronary compared to intravenous bolus abciximab during primary percutaneous coronary intervention in ST-segment Elevation Myocardial Infarction (STEMI) patients reduces 30-day mortality and target vessel revascularization: a randomized trial. J Interv Cardiol, 2011, 24(2): 105-111.
10. Eitel I, Friedenberger J, Fuernau G, et al. Intracoronary versus intravenous bolus abciximab application in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: 6-month effects on infarct size and left ventricular function. The randomised Leipzig Immediate PercutaneouS Coronary Intervention Abciximab i.v. versus i.c. in ST-Elevation Myocardial Infarction Trial (LIPSIAbciximab-STEMI). Clin Res Cardiol, 2011, 100(5): 425-432.
11. Thiele H, Wohrle J, Hambrecht R, et al. Intracoronary versus intravenous bolus abciximab during primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction: a randomised trial. Lancet, 2012, 379(9819): 923-931.
12. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1[updated March 2011].The Cochrane Collaboration, 2008. Available from:www.cochrane-handbook.org.
13. Thiele H, Schindler K, Friedenberger J, et al. Intracoronary compared with intravenous bolus abciximab application in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: the randomized Leipzig immediate percutaneous coronary intervention abciximab IV versus IC in ST-elevation myocardial infarction trial. Circulation, 2008, 118(1): 49-57.
14. Gu YL, Kampinga MA, Wieringa WG, et al. Intracoronary versus intravenous administration of abciximab in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention with thrombus aspiration: the comparison of intracoronary versus intravenous abciximab administration during emergency reperfusion of ST-segment elevation myocardial infarction (CICERO) trial. Circulation, 2010, 122(25): 2709-2717.
15. Dominguez-Rodriguez A, Abreu-Gonzalez P, Avanzas P, et al. Intracoronary versus intravenous abciximab administration in patients with ST-elevation myocardial infarction undergoing thrombus aspiration during primary percutaneous coronary intervention--effects on soluble CD40 ligand concentrations. Atherosclerosis, 2009, 206(2): 523-527.
16. Iversen A Z, Galatius S, Abildgaard U, et al. Intracoronary compared to intravenous abciximab in patients with ST segment elevation myocardial infarction treated with primary percutaneous coronary intervention reduces mortality, target vessel revascularization and reinfarction after 1 year. Cardiology, 2011, 120(1): 43-49.
17. Galache OJ, Sanchez-Rubio J, Calvo I, et al. Does intracoronary abciximab improve the outcome of percutaneous coronary interventions? A randomized controlled trial. Rev Esp Cardiol, 2006, 59(6): 567-574.
18. Dave RM. Improving outcome of STEMI PCI: Preliminary Results of Crystal AMI trial. [2011-05-28]. Available from: http://www. clinicaltriairesults. org/slides/CRYSTAL_slid-es. PPT.
19. Wu TG, Zhao Q, Huang WG, et al. Effect of intracoronary tirofiban in patients undergoing percutaneous coronary intervention for acute coronary syndrome. Circ J, 2008, 72(10): 1605-1609.
20. 杨新春, 张大鹏, 王乐丰, 等. 冠状动脉内应用国产替罗非班对急性ST段抬高心肌梗死急诊介入治疗后心肌灌注和临床预后的影响. 中华心血管病杂志, 2007, 35(6): 517-522.
21. Deibele AJ, Jennings LK, Tcheng JE, et al. Intracoronary eptifibatide bolus administration during percutaneous coronary revascularization for acute coronary syndromes with evaluation of platelet glycoprotein IIb/IIIa receptor occupancy and platelet function: the Intracoronary Eptifibatide (ICE) Trial. Circulation, 2010, 121(6): 784-791.
22. Schneider DJ. Anti-platelet therapy: glycoprotein IIb-IIIa antagonists. Br J Clin Pharmacol, 2011, 72(4): 672-682.
23. Navarese EP, Kozinski M, Obonska K, et al. Clinical efficacy and safety of intracoronary vs. intravenous abciximab administration in STEMI patients undergoing primary percutaneous coronary intervention: a meta-analysis of randomized trials. Platelets, 2012, 23(4): 274-281.
24. Ronner E, Boersma E, Akkerhuis KM, et al. Patients with acute coronary syndromes without persistent ST elevation undergoing percutaneous coronary intervention benefit most from early intervention with protection by a glycoprotein Ⅱb/Ⅲa receptor blocker. Eur Heart J, 2002, 23(3): 239-246.
25. Friedland S, Eisenberg MJ, Shimony A. Meta-analysis of randomized controlled trials of intracoronary versus intravenous administration of glycoprotein IIb/IIIa inhibitors during percutaneous coronary intervention for acute coronary syndrome. Am J Cardiol, 2011, 108(9): 1244-1251.

《中国循证医学杂志》

冠脉注射血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂用于急性冠脉综合征经皮介入治疗的Meta分析

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《中国循证医学杂志》

冠脉注射血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂用于急性冠脉综合征经皮介入治疗的Meta分析

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