老年急性心肌梗死急诊介入治疗联合替罗非班的疗效评价

Efficacy and safety of tirofiban treatment combined with percutaneous coronary intervention in the elderly with acute ST segment elevation myocardial infarction

目的探讨老年急性ST段抬高心肌梗死（ASTEMI）患者急诊介入治疗联合应用国产替罗非班临床疗效的有效性及安全性。方法2008年5月至2010年5月发病12h内接受急诊PCI术的老年ASTEMI患者106例，年龄65～88（68．5±9．6）岁，按就诊顺序分为替罗非班治疗组（n=54）和对照组（n=52），比较两组基础临床特征、心肌呈色分级（MBG）及术后90min心电图ST段回落百分比（sumSTR），并观察住院期间主要心血管事件、左室射血分数及出血并发症。结果两组基础临床情况和造影特征差异无统计学意义（P〉0．05）。替罗非班组心肌呈色分级3级获得率明显增高（88．9％vs57．7％，P〈0．05），术后90min心电图ST段把抬高回落〉50％者（70．3％VS42．3％，P〈0．05）显著高于对照组。替罗非班组心肌梗死后1周射血分数也明显高于对照组（56．2±7．6VS46．7±8．5，P〈0．05）。两组住院期间主要心血管事件发生率比较差异无统计学意义（P〉0．05）。替罗非班组轻度出血发生率有高于对照组趋势（11.1％vs6．0％，P〉0．05），但无严重出血或血小板减少症。结论国产替罗非班能改善急诊PCI术后心肌灌注指标，并有助于改善心功能。老年ASTEMI患者急诊PCI联合使用替罗非班治疗是安全有效的。

Objective To analyze the efficacy and safety of tirofiban treatment combined with percutaneous coronary intervention （PCI） in the elderly with acute ST segment elevation myocardial infarction prospectively. Methods From May 2008 to May 2010, 106 patients who presented with acute STEMI within 12 hours from onset and received successful primary PCI were enrolled into the study. All patients had angiographic evidence of initial total occlusion of infarct-related artery and finally restored toTIMI3 flow after PCI. All patients were divided into tirofiban group （ n = 54 ） and control group （ n = 52 ） according to whether tirofiban was used or not. Assessment of myocardial perfusion included Myocardial Blush Grades （MBG） , and the resolution of the sum of ST-segment elevation （sumSTR） at 90 minutes after the procedure. Left ventricular ejection fraction （EF） was measured one week later. Major adverse cardiac events in hospital and bleeding complications were also assessed. Results Baseline clinical and angiographic characteristics of the two groups were similar. Significant higher rates of MBG 3 were observed in the tirofiban group （88.9% vs57.7%, P 〈 0.05）. Patients received tirofiban were more likely to achieve higher sumSTR （70. 3% vs 42. 3%, P 〈0. 05）. Ejection fraction was also markedly increased in tirofiban group than control group （56. 2 ±7. 6 vs 46. 7 ±8.5, P 〈0. 05）. In-hospital major adverse cardiac events, it was not different between the two groups （ P 〉 0. 05）. There were slightly more minor bleeding complications in tirofiban group compared with control（ 11.1% vs 6. 0%, P 〉0. 05）. No patient had major bleeding or thrombocytopenia.Conclusions Tirofiban can further ameliorate microvascular perfusion and it is safe and feasible for patients with STEMI undergoing primary PCI.