静脉内和冠脉内同时应用替罗非班在急性心肌梗死介入治疗中的疗效与安全性

Efficacy and safety of intravenous combined with intracoronary administration of tirofiban bolus in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention

目的:评价静脉内和冠脉内同时应用负荷剂量替罗非班在急性ST段抬高心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)中的疗效和安全性。方法:43例拟行急诊PCI术STEMI患者随机选入替罗非班IV组(仅静脉内推注负荷剂量替罗非班,22例)和替罗非班IV&IC组(静脉内和冠脉内同时推注负荷剂量替罗非班,21例),观察患者PCI术前术后thrombolysis in myocardial infarction trial(TIMI)血流分级和心肌组织灌注,住院期间心脏超声、主要不良心血管事件(MACE)、出血事件和血小板减少,以及术后30d的MACE。结果:两组患者的基础临床情况和术前冠脉造影特征差异无统计学意义;两组患者术后TIMI血流分级,校正的TIMI帧数计数(CTFC)≤27帧差异无统计学意义;术后心电图ST段抬高总和回落(sumSTR)百分比≥70%,肌钙蛋白I(cTnI)与肌酸激酶同工酶(CK-MB)峰值浓度等差异无统计学意义;住院期间左室收缩功能、MACE、大量出血事件、血小板减少症的发生率等差异无统计学意义;两组术后30dMACE发生率差异无统计学意义。结论:在STEMI患者急诊PCI术中,静脉内和冠脉内同时应用负荷剂量替罗非班是安全的,近期疗效与单纯静脉内应用替罗非班相当。

Objective： To assess the safety and efficacy of simultaneous intravenous plus intracoronary administration of tirofiban bolus for patients with acute ST-elevation Myocardial infarction（STEMI） undergoing primary percutaneous coronary intervention （PCI）. Methods： Forty-three patients with acute STEMI ready to receive primary PCI were randomly divided into tirofiban IV group （intravenous tirofiban bolus only before stent deployment, n = 22） or tirofiban IV＆IC group （intravenous plus intracoronary administration of tirofiban bolus simultaneously, n = 21 ）. The thrombolysis in myocardial infarction trial and perfusion of the myocardium were observed before and after PCI. Major adverse cardiovascular event （MACE）, hemorrhage event,and thrombocytopenia were observed during hospital stay; MACE was also observed 30 days after PCI. Results： The clinical characteristics and baseline angiographic findings were similar in the two groups. After PCI, no difference was observed in the final TIMI flow grade 3, CTFC≤ 27, sumSTR≥ 70 % between the two groups （P = 0. 951,0. 933,0. 666, respectively）. There was no significant difference in the frequencies of MACE （P= 0. 101） and the left ventricuiar ejection fraction between the two groups （P=0. 694）. No major hemorrhage or severe thrombocytopenia were found in the two groups during hospital stay. The total rate of bleeding was also similar in the two groups （P= 0. 558）. The frequencies of MACE were similar in the two groups 30 days after operation. Conclusion.. Simultaneous intravenous and intracoronary administration of tirofiban bolus is safe for STEMI patients undergoing primary PCI; the short-term efficacy is similar to that of intravenous administration only.