早期应用替罗非班对急性心肌梗死患者直接PCI疗效的初步观察

Effects of early use of tirofiban in patients with acute myocardial infarction on primary percutaneous coronary intervenion

目的探讨不同时间应用替罗非班对急性心肌梗死(AMI)患者直接PCI的疗效。方法急诊入院的60例AMI患者随机分为早期组(30例)或晚期组(30例),早期组于急诊入院时或晚期组于导管室时推注负荷量10μg/kg的替罗非班,继之0.15μg·kg-1·min-1静脉滴注维持24～36h。比较两组间PCI前、后的TIMI血流分级、TIMI心肌灌注分级(TMP)、心功能、血小板聚集率及出血情况。记录住院期间及随访3个月的主要心脏不良事件(MACE)发生率。结果术前早期组TIMI前向血流达到3级的比例明显高于晚期组(36.7%和13.3%,P=0.037);而术后早期组TIMI前向血流达到3级的比例与晚期组相比差异无统计学意义(82.37%和76.7%,P=0.519)。术前和术后的早期组TMP2～3级比例均高于晚期组(分别为33.3%和10.0%,P=0.028;83.3%和56.7%,P=0.024)。术后两组LVEF均较术前提高[早期组(52±8)%和(42±6)%,P=0.005;晚期组(49±9)%和(43±8)%,P=0.02]。术后两组血小板聚集率均较术前明显下降[早期组(44.7±14.5)%和(53.9±17.7)%,P=0.033;晚期组(46.0±18.4)%和(55.4±12.0)%,P=0.023],出血并发症及MACE发生率无显著性差异。结论急诊入院时尽早应用替罗非班对AMI患者直接PCI治疗是安全有效的,且能够更明显改善靶血管前向血流TIMI分级及心肌灌注TMPG分级。

Objective To compare the therapeutic effects on patients with acute myocardial infarction（AMI） treated by primary percutaneous coronary intervention between early use of tirofiban and late use. Methods 60 AMI patients with emergency admission were divided into two groups： early group and late group. Tirofiban was infused at 10 μg/kg within 3 minute, followed by infusion at 0.15 μg·kg-1·min-1 for 24-36 h. TIMI,TMP, LVEF,platelet aggregation rate and bleeding in both groups were respectively compared and the adverse cardiovascular event in the hospital and 3-month follow-up were also observed. Results The TIMI 3 flow rate was significantly higher in the early group than that in the late group（36.7% vs 13.3%,P=0.037）. However, there was no significant between two groups. TMP 2-3 rate in the early group, whether pro-procedural or post procedural, was higher than that in the late group（33.3% vs 10.0%,P=0.028, 83.3% vs 56.7%,P=0.024）. Although EF in the both group increased after PCI [（52±8）% vs（42±6）%,P=0.005,（49±9）% vs （43±8）%,P=0.02], the difference of pro-procedural or post-procedural EF between the early group and the late one respectively was no significant. Platelet aggregation rate of post-procedural in the both were lower than that of pre-procedural[（44.7±14.5）% vs （53.9±17.7）%,P=0.033,（46.0±18.4）% vs （55.4±12.0）%,P=0.023]. The bleeding complication and MACE occurrence rate had no significant difference between 2 groups.Conclusion Early use of tirofiban in patients with AMI treated by primary PCI was effective and safe. Early use of tirofiban could improve significantly target vessels forward blood flow TIMI and myocardial blush TMP.