老年急性冠状动脉综合征患者替罗非班冠状动脉和静脉用药的疗效比较

Therapeutic effect of intracoronary versus intravenous bolus tirofiban in elderly patients with acute coronary syndrome

目的分析老年急性冠状动脉（冠脉）综合征（ACS）患者替罗非班不同负荷和不同用药途径对心肌灌注和30d主要不良心血管事件（MACE）的影响，探讨替罗非班的负荷用药最佳途径。方法2009年7月至2010年7月，连续入选120例老年ACS患者，均行经皮冠状动脉介入术（PCI），术前开始用替罗非班。根据负荷给药途径不同分为两组：冠脉内用药组和静脉用药组，各60例。观察两组患者PCI后冠脉血流、心肌灌注及PCI术后30d的MACE。结果冠脉内用药组病变冠脉的急性心肌梗死溶栓试验（TIMI）血流分级3级、TIMI心肌灌注分级（TMPG）3级率明显高于静脉用药组[分别为53例（88．3％）、38例（63．3％）和40例（66．7％）]，两两比较，均P％0．05，但两组患者院内和PCI后30d的MACE[分别为1（1．7％）和0，3（5．0％）和5（8．3％）]及不同程度出血和血小板减少症发生率比较差异均无统计学意义。结论老年ACS患者PCI前冠脉内使用负荷剂量替罗非班与静脉内用药途径比较，能更有效地增加冠状动脉血流及心肌水平的灌注。

Objective To analyze the therapeutic effect of intracoronary versus intravenous bolus tirofiban on myocardial perfusion and major cardiovascular events （MACE） in elderly patients with non-ST segment elevation acute coronary syndrome （NSTE-ACS） and explore the optimal route of tirofiban application. Methods From July 2009 to July 2010, 120 NSTE-ACS patients undergoing percutaneous coronary intervention （PCI） were consecutively enrolled in this study. They were randomly divided into two groups： intracoronary （60 cases） versus intravenous （60 cases） bolus tirofiban. Thrombolysis in myocardial infarction （TIMI） flow, TIMI myocardial perfusion grade （TMPG） and MACE 30 days after PCI were observed. Results The incidence of TIMI flow and TMPG 3 grade in intracoronary group were higher than in intravenous group 53（88.3%） vs. 38 （63.3%）; 53（88.3%） vs. 40（66.7%）, respectively, both P〈0.051. However, MACE incidence and bleeding complications during hospital 30 days after PCI had no significant difference between the two groups （1 （1.7%） vs. 0; 3（5.0%） vs. 5（8.3%）, which were not statistically significant （P〉0.05）. Conclusions Intracoronary bolus tirofiban before PCI more effectively increases coronary blood flow and myocardium blush than intravenous route in elderly NSTE-ACS patients.