替罗非班对急性心肌梗死患者介入术后冠脉血流及左心室功能和心血管事件的影响

Effects of tirofiban on the recovery of coronary flow and the left ventricular function and the incidence of cardiovascular events after percutaneous coronary intervention in patients with acute myocardial infarction

目的:探讨盐酸替罗非班对急性心肌梗死直接冠脉介入术后心肌梗死溶栓试验(TIMI)血流以及左心室功能和心血管事件的影响。方法:将2005年2月至2007年4月我院心血管内科及CCU科110例急性心肌梗死患者中的急诊冠脉造影提示梗死相关动脉血流TIMI0～1级并拟行经皮冠脉介入(PCI)患者80例,分为试验组(盐酸替罗非班+PCI)40例和对照组(PCI)40例。收集所有病例的临床和冠脉造影资料,观察PCI术前、术后TIMI血流情况。术后7d进行二维超声心动图测定左室射血分数,并观察住院期间两组患者心血管事件的发生率。结果:两组患者的基本临床资料差异无统计学意义,术前梗死相关动脉TIMI血流无统计学差异。介入术后造影显示试验组95.0%的患者恢复TIMI3级血流,而对照组75.0%患者恢复TIMI3级血流,两组差异有统计学意义(P<0.05);试验组TIMI0～2级血流发生率为5.0%,而对照组为25.0%,两组比较差异有统计学意义(P<0.05)。住院期间试验组心血管事件(再梗死、死亡、反复心肌缺血发作)发生率较对照组低(P<0.05)。介入术后7d试验组患者左室射血分数[(58.0±6.6)%]较对照组[(52.4±8.2)%]明显提高(P<005)。结论:盐酸替罗非班能够改善急性ST段抬高型心肌梗死患者急诊冠脉介入术后梗死相关动脉血流,并能改善此类患者的左室功能,且降低了住院期间的心血管事件的发生率。

Objective To investigate the effects of tirofiban on recovery of coronary flow and the function of left ventricle and the incidence of cardiovascular events after percutaneous coronary intervention（PCI） in patients with acute myocardial infarction（AMI）. Methods In 110 patients who were diagnosed as AMI from Feb 2005 to Apt 2007 in our hospital, 80 patients with coronary artery TIMI blood flow 0-1 grade and underwent emergency PCI, were divided into study group （tirofiban ＋ PCI group, n=40） and control group （PCI group, n=40）. The basic clinical information and angiographic characteristics before and after PCI were collected and studied. The parameters of left ventricular function （LVEF） were determined with 2d-echocardiograph 7 days after PCI. The in-hospital cardiovascular events occmxed were assessed. Results There was no significant difference between the two groups in basic clinical or angiographic characteristics before PCI （P 〉 0.05）, 95.0% of patients in the study group were recovered with TIMI 3 grade flow and 5.0% of patients were just recovered with TIMI 0 - 2 grade flow. In the control group 75.0% of patients were restored TIMI 3 grade flow and 25.0% of patients were just recovered with TIMI 0 - 2 grade flow. The difference was found to be statistically significant （P 〈 0.05）. There was a lower incidence of in-hospital cardiovascular events （reinfarction, mortality and recurrent agina） in the study group than that in the control group （P 〈 0.05）. The LVEF was significantly higher in the patients of study group than that in the control group during in-hospital. Conclusion Tirofiban may improve TIMI flow of the IRA in patients with STEMI during emergency PCI, furtherly it has positive effect on the LVEF and lowers the incidence of cardiovascular events in these patients.