替罗非班对急性ST段抬高心肌梗死患者再灌注及住院期预后的影响

Influence of Tirofiban Therapy on Myocardial Perfusion and In-hospital Prognosis after Primary Percutaneous Coronary Intervention in Patients with Acute ST Elevation Myocardial Infarction

目的评估替罗非班对急性ST段抬高心肌梗死(STEMI)患者梗死相关动脉自发再通、经皮冠状动脉介入治疗(PCI)后心肌灌注及住院期预后的影响。方法连续入选316例急性STEMI患者,随机决定急诊室给予替罗非班(156例)与否(160例)。根据急诊冠脉造影结果分为TMP 0～1级组(218例)和TMP 2～3级组(98例)。所有TMP 0～1级患者均行紧急PCI,据替罗非班的应用情况分为替罗非班亚组(91例)与常规治疗亚组(127例)。分析替罗非班与梗死相关动脉自发再通、PCI术后心肌灌注、住院期主要心脏不良事件(MACE)的关系。结果 TMP 2～3级组甘油三酯、白细胞升高显著低于TMP 0～1级组(P<0.05),且替罗非班的应用比例显著高于TMP 0～1级组(P<0.01)。亚组分析表明,替罗非班组PCI术后即刻校正的TIMI桢数、住院时间、TMP 0～2级及住院期MACE发生率均降低(P<0.05),左室射血分数增高(P<0.05);高龄、替罗非班治疗、左室射血分数降低、术后TMP0～2级与住院期MACE发生率相关(P<0.05)。结论早期应用替罗非班可增加急性STEMI患者梗死相关动脉自发再通率,改善急诊PCI术后梗死区域心肌再灌注与住院期临床预后。

Objective To evaluate the influence of tirofiban therapy on spontaneous recanalization of infarct-related arteries,myocardial perfusion and in-hospital prognosis after primary percutaneous coronary intervention（PCI） in patients with acute ST elevation myocardial infarction（STEMI）.Mehods Three hundred and sixteen consecutive patients with acute STEMI were randomly treated with tirofiban or without,and divided into TMP G0～1 group（n=218） and TMP G2～3 group（n=98） by primary coronary angiography.All of the patients with TMP G0～1 were given primary PCI and were allocated into tirofiban group（n=91） or the control group（n=127）.The benefits of tirofiban therapy on spontaneous recanalization of culprit vessel,myocardial perfusion and in-hospital prognosis were assessed.Results Triglyceride and leucocyte level were significantly lower,and tirofiban therapy was more common in TMP G2～3 group.In the subgroup,underwent primary PCI,the corrected TIMI frame count,average hospital stay,left ventricular ejection fraction（LVEF）,TMP G0～2 and major adverse cardiac events（MACE） rates in tirofiban group were significantly superior to those in the control group.Age≥65 years,tirofiban therapy,LVEF50%,TMP G0～2 after PCI were independent predictors of MACE rates in the hospital.Conclusion Primary tirofiban therapy significantly increases spontaneous recanalization rate and myocardial perfusion level after primary PCI,and improves the prognosis of patients with acute STEMI.