替罗非班对急性STEMI患者急诊PCI治疗后心肌灌注左室功能及预后的影响

Effects of primary percutaneous coronary intervention combined tirofiban therapy in patients with acute ST-segment myocardial infarction

目的探讨急性ST段抬高心肌梗死(STEMI)患者急诊介入治疗时联合应用替罗非班对心肌灌注、左室功能及预后的影响。方法连续入选2006年6月至2007年12月确诊急性ST段抬高心肌梗死并接受急诊经皮冠状动脉介入治疗(PCI)患者100例,随机分为替罗非班组和对照组,比较两组患者的基线特征、术后即刻造影结果、术后7d及90d左室射血分数(EF)、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)及90d主要不良心血管事件(MACE)发生率。结果两组患者基线特征、介入治疗效果、TIMI3级血流差异无统计学意义,但替罗非班组校正TIMI帧数、术后2hST段回落程度、酶峰值及峰值时间均优于对照组。无复流发生率及90d主要不良心血管事件(MACE,包括死亡、再梗死、再次靶血管重建)发生率明显低于对照组。替罗非班组术后7d及90dEF、LVEDV、LVESV优于对照组。结论对于急性ST段抬高心肌梗死患者行急诊PCI联合静脉应用替罗非班治疗可减少无复流现象的发生,改善心肌水平再灌注状态,改善左室功能,提高临床预后。

Objective To study the offects of primary percutancous coronary intervention combined tirofiban therapy on myocardial perfusion and clinical outcomes in patients with acute ST - segment myocardial infarction. Methotis One hundred consecutive patients with acute STEMI were randomly allocated to either primary PCI combined with tirofiban therapy or primary PCI treatment alone. Baseline characteristics, left ventricular ejection faction （EF）, major adverse cardiac events （MACE） and so on were compared. Results The baseline clinical characteristics＇were comparable between the two groups. The TIMI grade 3 flow was similar between the tirofiban and control groups, but the TIMI frame count, resolution of sum of ST-segment elevation, peak-value of CK-MB, EF, LVEDD, LVESD, and the MACE rates at 90 days in tirofiban group were superior to those in the control group. Conclusion Adjunctive therapy with tirofiban for patients with acute STEMI who undergo primary PCI can improve re-perfusion in the infarction area and clinical outcomes at 90 days.