常规早期开始与延迟选择性应用糖蛋白IIb/IIIa抑制剂治疗急性冠状动脉综合征的比较:ACUITY时限试验  

Routine upstream initiation vs deferred selective use of glycoprotein IIb/IIIa inhibitors in acute coronary syndromes:The ACUITY timing trial

作　　者：Stone G.W. Bertrand M.E. Moses J.W. 刘少伟 

机构地区：[1]Dr.Cardiovascular Research Foundation, Columbia University Medical Center, 111 E 59th St, New York, NY 10022, United States

出　　处：《世界核心医学期刊文摘（心脏病学分册）》2007年第8期1-2,共2页

摘　　要：背景:对于接受早期介入治疗策略的中危和高危急性冠状动脉综合征(ACS)患者,当前的指南推荐在血管造影前对所有患者应用或推迟到血管成形术前在导管室内选择性应用血小板糖蛋白IIb/IIIa(GpIIb/IIIa)抑制剂治疗,但尚不清楚哪种方法更好。目的:确定对接受早期介入治疗策略的中危和高危A CS患者应用GpIIb/IIIa抑制剂的最佳策略。设计:前瞻性、随机、开放标记试验,有30d的临床随访期。机构:17个国家的450所基于学院和社区的机构。患者:共9207例拟接受早期介入治疗策略的中危和高危ACS患者。Context: In patients with moderate- and high-risk acute coronary syndromes(ACS) who undergo an early, invasive treatment strategy, current guidelines recommend administration of platelet glycoprotein IIb/IIIa(Gp IIb/IIIa) inhibitors, either upstream to all patients prior to angiography or deferred for selective use in the catheterization laboratory just prior to angioplasty. The preferred approach is undetermined. Objective: To determine the optimal strategy for the use of Gp IIb/IIIa inhibitors in patients with moderate- and high-risk ACS undergoing an early, invasive treatment strategy. Design: Prospective, randomized, open-label trial with 30-day clinical follow-up. Setting: Four hundred fifty academic and community-based institutions in 17 countries. Patients: A total of 9207 patients with moderate- and high-risk ACS undergoing an invasive treatment strategy. Interventions: Patients were randomly assigned to receive either routine upstream(n=4605) or deferred selective(n=4602) Gp IIb/IIIa inhibitor administration, respectively. Main Outcome Measures: The primary outcome was assessment of noninferiority of deferred Gp IIb/IIIa inhibitor use compared with upstream administration for the prevention of composite ischemic events(death, myocardial infarction, or unplanned revascularization for ischemia) at 30 days, using a 1-sided α level of .025. Major secondary end points included noninferiority or superiority of major bleeding and net clinical outcomes(composite ischemia or major bleeding). Results: Glycoprotein IIb/IIIa inhibitors were used more frequently(98.3% vs 55.7% , respectively) and for a significantly longer duration(median, 18.3 vs 13.1 hours; P< .001) in patients in the upstream group compared with the deferred group. Composite ischemia at 30 days occurred in 7.9% of patients assigned to deferred use compared with 7.1% of patients assigned to upstream administration(relative risk, 1.12; 95% confidence interval, 0.97- 1.29; P=.044 for noninferiority; P=.13 for superiority); as such, the criterion for

关 键 词：ACUITY IIB/IIIA 早期介入治疗 选择性应用 血小板糖蛋白 血管成形术 最佳策略 血管造 

分 类 号：R541.4[医药卫生—心血管疾病]