替罗非班治疗女性急性冠脉综合征患者临床疗效及安全性评估

Impact of Tirofiban on Clinical Outcomes for Female Patients with Acute Coronary Syndromes

目的:评价替罗非班治疗女性急性冠脉综合症(ACS)患者的对主要心脏不良事件发生率及安全性的影响。方法:134例女性ACS患者随机分为替罗非班组(n=68)和对照组(n=66),对照组常规联合应用阿司匹林和氯吡格雷治疗,替罗非班组加用替罗非班治疗。观察两组48 h和30 d的主要不良心血管事件(再发心绞痛、心肌梗死和全因死亡)、出血以及血小板减少等副反应的发生情况。结果:用药后48 h两组均无心绞痛及心肌梗死发生病例。用药后30 d,替罗非班组有3例主要心脏不良事件,其中2例心绞痛,1例全因死亡;对照组有10例心脏不良事件,其中5例心绞痛,3例再发心肌梗死,2例全因死亡。替罗非班组于对照组相比,用药后30 d的主要心脏不良事件发生率明显降低(4.4%vs 15.2%),差异具有统计学意义,P<0.05。多因素Logistic回归分析表明,替罗非班治疗是降低女性ACS患者非介入治疗后30 d内主要心血管不良事件发生率的独立因素(OR=0.40,P<0.01)。两组总的出血发生率(8.8%vs 3.0%)及血小板减少发生率(1.5%vs 0%)差异无统计学意义,P>0.05。结论:替罗非班可显著改善降低女性ACS患者心绞痛及心梗的发生率,并不增加其出血及血小板减少的发生率,有较好的临床推广应用前景。

Objective:To investigate the impact of Tirofiban on clinical outcomes for female patients with acute coronary syndromes (ACS).Methods:134 female patients with ACS were randomized to received either Tirofiban (Tirofiban group,n=68) or nothing (control group,n=66) after administration of aspirin plus heparin.The clinical data were recorded and analyzed,including clinical characteristics,main adverse cardiac events (MACE) such as recurrent angina,myocardial infarction and death,and the adverse effects such as hemorrhage and thrombocytopenia. Results:No recurrent angina and myocardial infarction occurred in both groups within 48 hours after administration.In the Tirofiban group,recurrent angina occurred in 2 cases and death in another case within 30 days after administration.While in the control group,recurrent angina occurred in 5 patients and recurrent myocardial infarction in 3 patients,death occurred in one patient.Compared with control group,incidence rate of MACE at 30 days follow- up were significantly reduced in Tirofiban group (4.4% vs 15.2%,P<0.05).Multivariate logistic regression analysis revealed Tirofiban therapy was the only independent predictor of lower MACE at 30 days after discharge.No significance in hemorrhagic complications and thrombocytopenia was presented between the two groups (P>0.05). Conclusion:Adjunctive Tirofiban for female patients with ACS can improve clinical outcomes during follow-up.