GPIIbIIIa受体拮抗剂介绍.ppt

* 5833例UA患者48小时内行PCI术,在导管室前接受早期GPIIb/IIIa治疗的患者，住院期间的事件有减少的趋势。 This is an observational study from the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines (CRUSADE) registry. This slide makes the point that for in-hospital events there was a trend toward reduced events among those who received GP IIb/IIIa inhibitors prior to proceeding to the catheterization lab.1 1. Peterson E. CRUSADE registry data. Presented at: ACC 52nd Annual Scientific Session; March 30–April 2, 2003; Chicago, Il. * * Keeping in mind these issues we sought to compare the effects of upstream tirofiban versus downstream high bolus dose (HBD) tirofiban or abciximab on epicardial and tissue level perfusion and Troponin I release in high risk patients presenting with NSTE-ACS and treated with percutaneous coronary intervention (PCI). We hypothesized that patients who were treated with upstream tirofiban regimen would have a better tissue-level perfusion and reduced Troponin I release after interventions compared with patients who were treated with downstream HBD tirofiban and abciximab regimen. We also hypothesized that no significant difference would have found between downstream HBD tirofiban and abciximab regimen. * Patients were randomised to the three following treatment arms: CCU (upstream) tirofiban administration as a bolus dose of 0.4 ?g/kg per minute for a period of 30 minutes, followed by an infusion of 0.10 ?g/kg/min up to 12 hours after PCI; “in-cath lab” (downstream) high dose bolus (HDB) tirofiban of 25 ?g/kg per 3 min 10 minutes before PCI, followed by an infusion of 0.15 ?g/kg/min for 12 hours; and “in-cath lab” (downstream) abciximab bolus of 0.25 mg/kg 10 minutes before PCI, followed by 0.125 ?g/kg for 12 hours to a maximum of 10 ?g/min. * All patients underwent PCI within 24 to 48 hours of admission. Angiographic markers of epicardial flow and tissue-level perfusion were assessed on completion o