国产药物洗脱支架联合替罗非班治疗急性心肌梗死近中期疗效的临床观察

Curative effect of Rapamycin-eluting stent(Nanoplus Stent) combined with Tirofiban in emergency percutaneous coronary intervention of acute myocardial infarction

目的评价国产药物洗脱支架(乐普支架)联合替罗非班在急性心肌梗死急诊介入治疗中的安全性、有效性及近中期疗效。方法 2009年9月～2011年8月,共62例急性心肌梗死患者行急诊介入治疗,随机分为替罗非班组和对照组,替罗非班组在对病变血管经皮冠状动脉介入治疗(PCI)过程中置入乐普支架。所有患者术前均口服负荷量阿司匹林300 mg、氯吡格雷300 mg。术中推注肝素8000～10 000 U。球囊预扩张病变血管后,冠脉内注射10～15 ml替罗非班,PCI术后0.15 g/(kg·min)静脉滴注维持24～48 h,术后皮下注射低分子肝素5～7d,对照组患者未冠脉内注射替罗非班。结果两组患者一般资料比较,差异无统计学意义(P>0.05)。两组患者的梗死相关动脉PCI术后全部即刻再通,且梗死相关动脉即刻再灌注率,两者差异无统计学意义(P>0.05)。PCI术后替罗非班组梗死相关血管TIMI 3级血流获得率96.7%,高于对照组83.9%,差异有统计学意义(P<0.05),校正TIMI计桢数显示替罗非班组血流速度高于对照组,差异有统计学意义(P<0.05)。所有患者住院期间均未发生急性、亚急性血栓,均未发生心源性死亡、再发急性心肌梗死、急诊CABG和重复PCI等主要不良心脏事件。所有患者均接受了临床随访,均无不良心血管事件:再发心绞痛、心肌梗死、心力衰竭及猝死等发生。其中,32例患者术后6个月复查了冠状动脉造影,无一例发生支架内再狭窄。结论国产药物洗脱支架(乐普支架)联合替罗非班治疗用于急性心肌梗死急诊介入治疗,是安全、有效的方法,近中期效果良好。

Objective To determine the safety, efficacy and feasibility of Rapamycin drug-eluting stent （Nanoplus Stent） combined with Tirofiban in the emergency percutaneous coronary intervention of acute myocardial infarction （AMI）. Methods From September 2009 to August 2011, 31 patients with AMI were treated with Nanoplus stents combined with Tirofiban. All patients were given 300 mg Aspirin and 300 mg Clopidogrel orally before and intravenous 8000-10000 U Heparin during coronary artery stenting. After balloon valvuloplasty, 10-15 mL of Tirofiban were injected into the coronary arteries followed by O. 15 g/kg. min intravenous injection of Tirofiban for 24-48 h, and hypodermic injection of LMWH for 5-Tdays after the procedure. Results 42 Nanoplus stents were successfully implanted in 31coronary arteries of 31 patients. Apart from slow-reflow （1 patient） and hematoma （3）, no serious complications including acute or sub-acute thrombosis, recurrent myocardial infarction, emergency CABG or death from cardiac causes occurred in the early in- hospital follow-up. At three to six months, there were no major adverse cardiac events. Six months after the procedure, there was no in-stent restenosis in 16 patients, who underwent coronary angiography. Conclusion Rapamycin-eluting stent （Nanoplus Stent） combined with Tirofiban is safe with favorable short and medium-term effect in the emergency intervention of acute myocardial infarction.