老年急性ST段抬高心肌梗死患者介入联合替罗非班治疗临床疗效的观察

Efficacy and safety of tirofiban treatment combined with percutaneous coronary intervention in the elderly with acute ST segment elevation myocardial infarction

目的前瞻性研究老年急性ST段抬高心肌梗死(ASTEMI)患者急诊介入治疗早期联合应用替罗非班临床疗效的有效性及安全性。方法入选沈阳军区总医院2004年5月1日至2006年6月30日经冠状动脉造影证实为单支血管病变且行介入治疗的231例老年ASTEMI患者,年龄65～85岁,平均(72±9.3)岁,随机分为替罗非班治疗组(n=116)和对照组(n=115),对比观察两组术中靶血管开通情况、TIMI3级血流获得情况,术后90min内ST段回落情况,96h活化凝血时间(ACT)、肌酸激酶同工酶(CK-MB)酶峰时间,术中及术后重要脏器出血情况,术后30d不良心血管事件、持续ST段抬高情况及左心室射血分数(EF)。结果两组靶血管经皮冠状动脉介入(PCI)成功率无显著差异,术中及术后出血事件发生情况无显著差异;治疗组术中TIMI3级血流获得率、术后90min内ST段回落比例及30dEF值均优于对照组(94.0%vs83.5%,85.3%vs73.0%,65.3%±2.4%vs54.7%±7.0%,P<0.05),治疗组术后持续ST段抬高>0.2mV患者的比例明显低于对照组(1.7%vs12.2%,P<0.05),术后治疗组CK-MB酶峰时间较对照组提前(8.3h±0.6hvs12.1h±0.3h,P<0.05),30d治疗组不良心血管事件发生率明显少于对照组(心绞痛发生率2.6%vs13.9%,心肌梗死再发率0.9%vs8.7%,心源性死亡率0vs5.2%,P<0.05)。结论老年ASTEMI患者急诊介入治疗早期联合应用替罗非班安全有效。

Objective To analyse the efficacy and safety of tirofiban treatment combined with percutaneous coronary intervention （PCI） in the elderly with acute ST segment elevation myocardial infarction prospectively. Methods A total of 231 old patients form Jul 1,2004 to June 30,2006 in this hospital were divided randomly into tirofiban treatment group （n= 116） and control group （n= 115） . All patients were verified to have single vessel disease by coronary arteriography and underwent primary PCI. The rate of opening of the target vessel, the number of cases achieving TIMI 3 flow, lowering of ST segment 90 min after PCI, activated coagulation time 96 h after PCI,the time to peak serum CK-MB levels, the cases of haematoma and main organ bleeding, main acute coronary event （MACE） 30 days after PCI, the cases of persistent ST segment elevation and the left ventricular ejection fraction （LVEF）were compared between the 2 groups. Results The rate of opening of the target vessel was similar between the 2 groups. No severe bleeding occurred in both groups. More patients achieved TIMI 3 flow and lowering of ST segment 90 rain after PCI and less people with persistent ST segment elevation in tirofiban treatment group than those in control group（94.0% vs 83.5%,85.3% vs 73.0%, 1.7% vs 12.2%,P〈0.05,respectively）. The LVEF of treat- ment group was better than that of the control group（65.3 %± 2.4 % vs 54.7%±7.0% ,P〈0.05）. Time to peak of serum CK-MB level in tirotiban tratment group was shorter than that in control gronp （8.3h±0.6h vs 12. 1h±0.3h, P〈0.05）. The rate of MACE 30 days after PCI was lower in tirofiban treatment group than in control graup （angina 2.6 % vs 13.9 %, reinfaretion 0.9 % vs 8.7 %, cardiac death 0 vs 5.2 %, P〈0.05）. Conclusion Tirofiban treatment combined with PCI in the elderly with acute ST segment elevation myocardial infarction is effective and safe.