替罗非班对急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗术后心肌生化标志物及临床预后的影响

Impact of Tirofiban on Myocardial Biomarkers and Clinical Outcomes After Primary Coronary Stenting in Patients With Acute ST-Segment Elevation Myocardial Infarction

目的:前瞻性评价替罗非班对急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)术后肌酸激酶混合型同工酶、肌钙蛋白I、酶性心肌梗死面积以及主要心脏不良事件(MACE)发生率的影响。方法:183例接受急诊PCI治疗的STEMI患者,随机分为替罗非班组(92例)和对照组(91例)。比较两组基础临床情况、介入治疗结果、急诊PCI术前和术后血清肌酸激酶混合型同工酶、肌钙蛋白I、酶性心肌梗死面积、住院期和术后180天左心室射血分数及MACE发生率。结果:替罗非班组与对照组相比,基础临床情况、介入治疗结果及术前肌酸激酶混合型同工酶、肌钙蛋白I水平差异均不具有统计学意义(P>0.05)。替罗非班组与对照组相比,急诊PCI术后肌酸激酶混合型同工酶峰值(P<0.01)和肌酸激酶混合型同工酶均值(P<0.01)、肌钙蛋白I峰值(P=0.01)和肌钙蛋白I均值(P<0.05)、酶性心肌梗死面积(P<0.05)均显著降低,差异均具有统计学意义。替罗非班组与对照组相比,住院期及术后180天左心室射血分数(P<0.05～0.01)明显增加,MACE发生率(P<0.05)显著降低,差异均具有统计学意义。多因素回归分析表明,替罗非班治疗是降低STEMI患者急诊PCI术后180天MACE发生率的独立决定因素(OR=0.39,P<0.01)。替罗非班组术后出血并发症发生率高于对照组,但差异不具有统计学意义(P>0.05)。结论:替罗非班能显著降低STEMI患者急诊PCI术后肌酸激酶混合型同工酶、肌钙蛋白I峰值和均值,明显缩小酶性心肌梗死面积,并显著改善住院期及术后180天临床预后。

To prospectively investigate the impact of platelet glycoprotein Ⅱ b/Ⅲa inhibitor tirofiban on myocardial biomarkers and clinical outcomes after primary pereutaneous coronary intervention （PCI） in patients with acute ST-segment elevation myocardial infarction （STEMI）. Methods ： One hundred and eighty-three consecutive patients with STEMI were randomized to receive either tirofiban and primary PCI （ Tirofiban group, n=92） or primary PCI alone （ Control group, n=91）. Baseline characteristics, PCI features, enzymatic infarct size,average and peak levels of creatine kinase-MB and troponin I on admission and 72 hours after procedure were compared between groups, as well as left ventricular ejection fraction and major adverse cardiac events （MACE） including death/ reinfarction/target vessel revascularization during hospitalization and 180 days after discharge. Resuhs： Basic clinical characteristics, PCI features, ereatine kinase-MB and troponin I levels on admission were similar between the two groups （P〉0.05）, but the peak levels of creatine kinase-MB （P 〈 0.01 ） and troponin I（P=0.01 ） ,the average levels of ereatine kinase-MB （P〈0.01） and troponin I （P〈0.05）, enzymatic infarct size （ P 〈 0. 05 ） were significantly lower in Tirofiban group. Compared with control group, left ventricular ejection fraction during hospitalization （P〈0.05）and at 180-day follow-up（P 〈0.01）were significantly improved in tirofiban group,as well as MACE（ hospitalization,5.4% and 14. 3%, P〈0.05 ;180-day follow-up,6. 5% and 16.5% ,P〈0.05）. Multivariate logistic regression analysis revealed tirofiban therapy was the only independent predictor of lower MACE at 180 days after discharge （OR=0.39, P〈0.01）. No significant difference in hemorrhagic complications was presented between the two groups （P〉0.05）. Conclusion ： Adjunctive tirofiban therapy for patients with STEMI who undergo primary coronary stenting significantly reduces the peak and average levels of myocardial biomarkers and enzymatic infarct size, which result in an improvement in left ventricular function and clinical outcomes during follow-up.