急性心肌梗死患者急诊介入治疗中应用盐酸替罗非班对无复流的影响

Influence of tirofiban on no-reflow phenomenon in patients with acute myocardial infarction receiving emergency percutaneous coronary intervention

目的评价急性心肌梗死患者冠状动脉急诊介入治疗中应用盐酸替罗非班对无复流现象的影响。方法自2006年1月至2008年12月,共104例接受急诊经皮冠状动脉介入(PCI)治疗的急性心肌梗死患者纳入研究,治疗组48例,对照组56例。比较两组间的基础临床状况、造影情况、介入治疗结果。病变血管术后均行TIMI分级、TIMI计帧。结果两组间的基础临床状况、术前造影情况差异均无显著性。但治疗组与对照组介入治疗后TIMI3级血流为91.7%和76.8%(P=0.0408),发生无复流现象为4.2%和16.1%(P=0.0491),远端小血管栓塞为8.3%和23.2%(P=0.0408),TIMI帧数为20.2±2.8和31.2±4.4(P=0.0225),治疗组优于对照组,两组均无严重出血事件发生,主要心血管事件(12.5%vs8.9%,P=0.011)对照组明显高于治疗组。结论急性心肌梗死患者急诊PCI治疗中应用盐酸替罗非班,可以改善术后梗死相关动脉无复流现象。

Objective To evaluate the effects of tirofiban on no-reflow phenomenon in patients with acute myocardial infarction （AMI） receiving emergency percutaneous coronary intervention （PCI）. Methods From January 2006 to December 2008, 104 AMI patients were divided into tirofiban treatment and control groups （n= 48 and 56, respectively） according to whether tirofiban was applied during emergency PCI. The patients＂ basic clinical characteristics, angiographic results, and PCI efficiency were compared between two groups. Thrombolysis in Myocardial Infarction study （TIMI） grading and TIMI frame count （TFC） were performed in all culprit vessels after emergency PCI. Results There was no significant difference between two groups in basic clinical characteristics and preopera- tive angiogram. Compared with control group, better TIMI 3 blood flow （91.7% vs 76. 8 %, P =0. 0408）, less noreflow rate （4. 2% vs 16.1%, P=0. 0491）, less distal embolization rate （8. 3 % vs. 23. 2 %, P =0. 0408） and better TFC （20. 2±2. 8 vs 31.2±4. 4, P=0. 0225） were achieved in tirofiban treatment group. No severe bleeding complication occurred in any patients. Major adverse cardiac events were significantly higher in control group than in tirofiban treatment group （12. 5% vs 8. 9%, P=0. 011）. Conclusion Tirofiban used during emergency PCI in patients with AMI can effectively prevent no-reflow phenomenon.