替罗非班治疗ST段抬高急性心肌梗死冠状动脉再通患者的临床特征及预后分析

Prognosis of acute myocardial infarction patients with infarct - related artery patency after tirofiban application

目的回顾性分析血小板GPⅡb／Ⅲa受体拮抗药替罗非班治疗急性心肌梗死（AMI）梗死相关血管自发性再通患者的临床特征及住院期和远期预后。方法152例AMI患者口服阿司匹林、氯吡格雷基础上加用替罗非班，急诊血管造影显示，前向血流TIMI2—3级为自发再通组（75例），TIM10～1级经冠状动脉介入治疗（PCI）后前向血流TIMI2—3级为PCI再通组（74例），3例因未达到TIMI2—3级剔除本研究。比较两组的临床特征及住院期和远期预后。结果两组临床特征比较差异无统计学意义。与PCI再通组比较，自发再通组术后30、180d主要不良心脏事件（MACE）（包括死亡、再梗死和再次靶血管重建）显著减少（P〈0．05），左室射血分数（LVEF）显著增加（P〈0．05）。多因素回归分析显示，梗死前心绞痛（OR=0．36，P=0．03）、胸痛时间〈6h（OR=0．56，P〈0．05）是梗死相关血管白发性再通的独立决定因素。结论应用GPⅡb／Ⅲa受体拮抗药替罗非班治疗急性ST段抬高型心肌梗死的梗死相关血管自发性再通患者预后较好。

Objective To retrospectively analyze the prognosis of acute myocardial infarction patients with infarct - related artery patency after tirofiban application. Methods 152 patients with ST - elevated acute myocardial infarction who received intravenous tirofiban application after emergency coronary angiography or PCI for the patients with forward blood flow TIMI 0 - 1. The patients with forward blood flow TIMI 2 - 3 at the initial angiography were classified as group 1（ n = 75 ） and those with TIMI 2 - 3 after successful PCI as group 2 （ n = 74）. 3 cases failed to reach TIMI 2 - 3 were excluded from this study. Clinical characteristics, in -hospital and longterm prognosis were compared between the two groups. Results There was no difference in clinical characteristics between the two groups apart from more patients with pre - AMI angina （ OR = 0. 36, P = 0. 03 ） and the onset of chest pain within 6 hours （ OR =0. 56 . P 〈 0. 05 ） in group 1 . Compared with the patients in group 2, the patients in group 1 had increased LVEF （ P 〈 0.05 ） and less major adverse cardiac events （ including cardiac death, re - infarction and target vessle revascularization ） at 30 days and 180 days after the operation （ P 〈 0.05）. Conclusion After the application of tirofiban in the patients with ST - segment elevation acute myocardial infarction, the infarct - related artery spontaneous patency have better prognosis than those via PCI.