糖蛋白Ⅱb／Ⅲa受体拮抗剂治疗高危急性冠脉综合征的应用时限研究

R outin upstream initiation vs deferred selective use of glycoprotein IIb/IIIa inhibitors in high-risk acute coronary syndromes

目的:探讨接受早期介入治疗的高危急性冠脉综合征(ACS)患者,血小板膜糖蛋白(GP)Ⅱb/Ⅲa受体拮抗剂的最佳应用时机。方法:选择接受早期冠脉介入治疗(PCI)的高危不稳定型心绞痛/非ST段抬高心肌梗死(UA/NSTEMI)患者162例,按替罗非班使用时机分常规早期治疗组和延期选择性治疗组,分别评估两种治疗方案对PCI术前、术后心肌组织水平灌注和30天复合心血管事件发生率的影响。结果:PCI术前TMPG分级0～1级患者共65例(40.1%),其中早期治疗组27例(32.9%),延期治疗组38例(47.5%);统计显示早期治疗组PCI术前TMPG分级0～1级发生率显著低于延期治疗组(P<0.05)。30天复合心血管事件及出血发生率两组无差异(P>0.05)。结论:GPⅡb/Ⅲa拮抗剂早期治疗能改善PCI术前心肌微循环,提高组织水平灌注。

Objective：To determine the optimal strategy for the use of glycoprotein Ⅱb/Ⅲa （Gp Ⅱb/Ⅲa） inhibitors in patients with high-risk acute coronary syndromes （ACS） receiving an early invasive treatment. Methods：One hundred and sixty-two patients with high-risk ACS undergoing early pereutaneous coronary syndromes were assigned to receive either routine upstream（n = 82） or deferred selective （n =80） Gp Ⅱb/Ⅲa inhibitor treatment. The authors evaluated the effects of two strategies on tissue-level perfusion using the TIMI myocardial perfusion grade （TMPG） before and immediately after PCI. Blooding complications and the 30 day composite end point events were also evaluated. Results：Among all the total 162 patients, the TMPG 0-1 perfusion were observed in 65 patients （40.1%）. The TMPG 0-1 perfusion was significantly less frequent in routine upstream treatment （n = 27） than in deferred selective group（n = 38） before PCI（32.9% vs 47.5%, respectively; P 〈 0.05）. No differences were seen both in 30 day composite end point events and bleeding complications. Conclusion：Among high-risk ACS patients treated with an early invasive strategy, routine upstream use of Gp Ⅱb/Ⅲa inhibitors is associated with tissue-level perfusion improved and without bleeding complications increased.