直接冠脉内注射替罗非班在急性心肌梗死患者急诊PCI中治疗疗效的研究

Safety and efficacy study of direct intra-coronary injection of Tirofiban in patients with acute myocardial infarction undergoing emergency percutaneous coronary intervention

目的探讨在急性心肌梗死(包括ST段抬高及非ST段抬高心肌梗死)患者行急诊PCI的过程中,冠脉内注射替罗非班继之静脉内持续泵入使用的安全性,以及能否进一步改善患者的急诊PCI疗效及减少术后近期心血管事件的发生率。方法回顾性分析2008年12月—2010年12月,37例急性心肌梗死患者行急诊PCI治疗时冠脉内注射了替罗非班继之静脉持续维持,另将同期的37例急性心肌梗死行急诊PCI时仅静脉内使用替罗非班的患者作为对照组,比较两组间的基础临床状况,术前术后梗死相关血管(IRA)的TIMI血栓积分(TIMI Thrombus Score)、TIMI血流分级(TIMI Flow Grades)、校正的TIMI血流帧数计数(Corrected TIMI Frame Count)、TIMI心肌灌注(TIMI Myocardial Perfusion)情况以及术后90 min心电图ST段回落百分比(sum-STR),以及住院期间主要心血管事件、出血事件及左室射血分数等。结果两者基础临床情况差异无显著性(P>0.05),冠脉内注射替罗非班继之静脉维持组术后达到TMP分级2级以上获得率(分别为94.6%和67.6%,P=0.003)、校正的TIMI帧数<25帧获得率(分别为91.9%和64.9%,P=0.005)、术后90 min心电图ST段回落百分比(sumSTR)(分别为67.6%和27.0%,P=0)、术后1周的射血分数[(56.62±6.897)和(51.59±6.817),P=0.002)]高于对照组,而两组的TIMI 3级血流的获得率以及两组住院期间的主要心血管事件发生率、出血事件发生率差异无显著性(P>0.05)。结论在急性心肌梗死患者行急诊PCI治疗中冠脉内注射替罗非班继之静脉维持是安全的,可以提高心肌微血管水平的灌注,从而改善患者的短期临床预后,长期预后情况仍需进一步研究。

Objective To assess the safety and efficacy of direct intra-coronary injection of tirofiban followed by transfusion via vein in patients with acute myocardial infarction（AMI） undergoing emergency percutaneous coronary intervention（PCI）.Methods Between Dec 2008 and Dec 2010,74 patients with AMI were randomly assigned into tirofiban group and conventional PCI group,37 patients were given tirofiban intra coronary artery undergoing emergency PCI in tirofiban group,followed with continuous transfusion via vein,while the other 37 patients were treated by conventional PCI during the same period,who were only given tirofiban via vein undergoing emergency PCI.The basic clinic condition,TIMI thrombus score,TIMI flow grades,corrected TIMI frame count,TIMI myocardial perfusion and the resolution of the sum of ST-segment elevation（sumSTR） at 90 minutes after the procedure,recent cardiaovascular events,bleeding events before and after the procedure and left ventricular ejection fraction（EF） were compared between the two groups.Results No significant differences were shown in basic clinic condition,TIMI Ⅲ flow grades acquirtion,recent major cardiaovascular events and bleeding events between the two groups（P 0.05）,but the former group acquire more TMP Grade 2 or 3 than the latter group（94.6% vs 67.6%,P = 0.003） and lower corrected TIMI frame count（91.9% vs 64.9%,P = 0.005）,and patients received tirofiban from direct injection into coronary artery were more likely to achieve higher sumSTR（67.6% vs 27.0%,P = 0） and EF after one week [（56.62 ± 6.897） vs（51.59 ±6.817）,P =0.002） ].Conclusion The study demonstrates that direct injection of tirofiban into crornary artery can be safe and efficient,which can improve the myocardial microcirculation reperfusion and patients’short-time prognosis,but long-time prognosis still needs more investigations.