老年高危急性冠状动脉综合征患者介入术中应用替罗非班的有效性和安全性

Glycoprotein Ⅱb/Ⅲa receptor inhibitors (tirofiban) in percutaneous coronary intervention for elderly high-risk patients with acute coronary syndrome

目的研究老年高危急性冠状动脉综合征(ACS)国人经皮冠状动脉介入术(PCI)中应用替罗非班的有效性和安全性。方法将2004年12月至2006年6月连续的94例老年高危ACS患者随机分为替罗非班治疗组和常规PCI组,前者PCI术前给予替罗非班+半量肝素治疗,后者仅以全量肝素治疗,比较两组PCI术后即刻罪犯血管(CV)的TIMI血流分级,术后6、12h肌酸激酶同工酶(CK-MB)的改变以及术后30d内的主要不良心脏事件(MACE)的发生率、术后出血的发生率和需要输血的比例。结果术后即刻替罗非班组和常规PCI组CV的TIMI血流分级(计帧法)分别为35.6±6.1和38.7±8.2;两组6、12h的CK-MB分别为16.2±3.9mmol/L、13.4±3.9mmol/L和18.4±4.8mmol/L、15.5±5.1mmol/L(P<0.05),而两组间术后30d的MACE发生率以及术后出血、输血的比例差异无统计学意义。结论老年高危ACS患者介入术中使用血小板膜糖蛋白Ⅱb/Ⅲa受体拮抗剂替罗非班是安全、有效的,其疗效优于常规治疗。

Objective To investigate the efficacy and safety of glycoprotein Ⅱ b/Ⅲ a inhibitor （tirofiban） for elderly high-risk patients with acute coronary syndrome （ACS） undergoing percutaneous coronary interventional therapy （PCI）. Methods Ninety four high-risk ACS patients admitted between Dec 2004 and Jul 2006 were randomly divided into the tirofiban group （ n = 46, mean age 68.5 ± 11.4 years old） .whom received tirofiban and half-dose of heparin, and the conventional interventional group （ n = 48, mean age 66. 8 ± 9. 9 years old） whom were treated by full dose heparin before PCI. The coronary reperfusion flow （ TIMI grades） of culprit vessel （CV） after PCI, cardiac enzyme changed 6 hrs and 12 hrs afterwards, major adverse cardiac events （MACE） rates within 30 days, bleeding and transfusion rates were analyzed and compared between the two groups. Results The average TIMI reperfusion grades （by frames） and CK-MB levels at 6 hrs and 12 hrs after PCI were better in the tirofiban group than in the conventional group （35.6 ± 6. 1, 16.2 ±3. 9 retool/L, 13. 4 ±3.9 mmol/L vs 38. 7 ±8. 2, 18. 4 ±4. 8 mmol/L, 15.5 ±5.1 mmol/L, P 〈 0. 05 ） respectively. There were no differences of MACE rates within 30 days after PCI and of complications of bleeding and transfusion rates between the two groups. Conclusion The results suggest that tirofiban is a safe and more efficacious therapy for elderly high-risk patients with ACS during PCI compared with conventional therapy.