替罗非班对复杂冠脉病变植入药物洗脱支架后亚急性血栓的影响

Impact of tirofiban on subacute thrombosis after drug-eluting stents implantation in complex coronary lesions

目的评价替罗非班对冠脉复杂病变介入治疗的安全性及对药物洗脱支架内亚急性血栓的影响。方法回顾性分析自2005年1月至2008年12月连续在解放军总医院老年心血管病研究所住院并行冠脉介入治疗的复杂冠脉病变患者289例,根据围手术期替罗非班使用率的多少分为第一阶段(即使用率较少组)171例和第二阶段(即使用率较多组)118例,分别记录两个不同阶段患者的临床特征、冠脉病变情况、支架植入情况、替罗非班使用率、出血并发症及亚急性血栓发生情况,观察并分析替罗非班对复杂冠脉病变行介入治疗的安全性及对支架内亚急性血栓形成的影响情况。结果两个阶段的冠心病患者的临床资料无统计学差异,两个阶段冠脉病变为B2和C型病变的患者分别为108、63例比78、40例,无统计学差异,两个阶段平均植入支架的数量分别为(3.1±1.3)枚和(2.9±1.2)枚,平均植入支架的总长度分别为(34.4±14.3)mm和(36.5±16.3)mm,均无统计学差异。两个阶段替罗非班使用率分别为15.2%比62.7%,有显著性差异。两个阶段出血并发症的发生率分别为4.67%和4.23%,无统计学差异。两个阶段支架内亚急性血栓的发生率分别为1.75%和0%,无统计学差异,但有减少的趋势。结论复杂冠脉病变植入药物洗脱支架的围手术期使用替罗非班是安全的,且降低了支架内亚急性血栓发生的趋势。

Objective To evaluate the security of tirofiban and its effects on subacute thrombosis after implantion of drug-eluting stents （DES） in complex coronary lesions. Methods A cohort of consecutive complex coronary heart disease （CHD） patients,who received implantation of DES from Jan,2005 to Dec,2008,were analyzed retrospectively. Totally 289 patients were divided into two different stages according to frequency of tirofiban use. There were 171 patients with less frequency of tirofiban use during the first stage,and 118 patients with more frequency of tirofiban use during the second stage. The clinical features,coronary artery lesions,DES implantation,frequency of tirofiban use,bleeding complication,and occurrence of subacute thrombosis in patients at two stages were recorded respectively. The security of tirofiban and its effects on subacute thrombosis after DES implantation were analyzed. Results There was no statistical difference in patients＇ clinical data between two stages. Patients with coronary lesions of type B2 and type C were 108 and 63 in first stage and 78 and 40 in second stage respectively （P0.05）. There was no statistical difference in total length and number of implanted stents between two stages（34.4±14.3） mm vs （36.5±16.3） mm,（3.1±1.3） vs （2.9±1.2）,P0.05. Compared with the first stage,there were more patients who used tirofiban in the second stage （15.2% vs 62.7%,P0.01）. The occurrence of bleeding complication between two stages was not statistically different （4.67% vs 4.23%,P0.05）. There was no statistical difference in the occurrence of subacute thrombosis between two stages,which was 0% and 1.75% respectively,but there was a decreasing tendency with more frequent use of tirofiban. Conclusion It is safe to use tirofiban after the implantation of drug-eluting stents in complex coronary lesions. It may also have the tendency to reduce the occurrence of subacute thrombosis.