阿昔单抗与冠状动脉支架置入术后血管造影显示再狭窄的关系:来自ISAR-REACT试验(一项安慰剂对照的随机双盲试验,旨在评估在给予高负荷剂量氯吡格雷后行择期经皮冠状动脉介入的患者使用阿昔单抗的作用)血

来源 :世界核心医学期刊文摘(心脏病学分册) | 被引量 : 0次 | 上传用户:WieldWolf
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Background: ISAR-REACT was a trial designed to evaluate whether the glycoprotein IIb/IIIa inhibitor abciximab is beneficial in patients undergoing elective percutaneous coronary intervention(PCI) with stent placement after pretreatment with a 600 mg loading dose of clopidogrel. Objective for the angiographic substudy was to determine the impact of abciximab on angiographic restenosis after coronary stent placement. Previous analyses have suggested a reduction in the incidence of restenosis after the administration of abciximab. Methods: The angiographic substudy comprises 1885 of 2159 patients enrolled in ISAR-REACT: 994 patients were randomly assigned to abciximab and 941 patients to placebo. All patients were scheduled for a routine angiographic follow-up after 6 months(performed in 80%of eligible patients). End points for the angiographic substudy were the rates of angiographic restenosis(≥50%diameter stenosis) and target lesion revascularization. Results: The incidence of angiographic restenosis was 27%in the abciximab group and 29%in the placebo group(relative risk 0.92, 95%CI 0.79-1.06, P=.27). Late angiographic lumen loss was 0.95±0.68 and 0.99±0.70 mm, respectively(P=.25). Similar results were obtained in a subgroup analysis focusing on high-risk subsets. The rate of target lesion revascularization procedures was 22%in the abciximab group and 23%in the placebo group(relative risk 0.94, 95%CI 0.79-1.12, P=.52). Conclusions: In low-to intermediate-risk patients who undergo elective PCI after pretreatment with a high loading dose of clopidogrel >2 hours before PCI, the additional administration of the glycoprotein IIb/IIIa inhibitor abciximab is not associated with a significant reduction in angiographic restenosis.
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