冠脉内注射替罗非班和硝普钠对直接PCI治疗术中无复流的疗效比较

The effect comparison of intracoronary injection of tirofiban versus sodium nitroprusside on no-reflow during primary PCI

目的比较急性ST段抬高心肌梗死(STEMI)患者直接PCI术中出现无复流时,冠脉内推注血小板GP IIb/IIIa受体拮抗剂替罗非班和硝普钠的疗效。方法替罗非班组为2009年2月至2012年10月STEMI患者行PCI术中出现无复流现象后给予冠状动脉内注入替罗非班的患者54例;以同期急性STEMI患者行PCI术中出现无复流现象后给予冠状动脉内注入硝普钠患者(硝普钠组)52例为对照组。观察2组患者注射药物后冠状动脉造影图像,测定PCI时梗死相关动脉TIMI血流,计算校正TIMI计帧数(cTFC),观察术后30 d心绞痛、主要心脏事件(MACE)的发生率及左室射血分数(LVEF)。结果冠状动脉内注射药物后冠状动脉造影显示:替罗非班组TIMI 3级血流比例明显高于硝普纳组(62.96%vs 42.31%,P<0.05);替罗非班组cTFC明显少于硝普钠组[(38.6±7.2)vs(49.4±9.5),P<0.01];替罗非班组术后30 d心绞痛发生率(5.56%vs 21.15%,P<0.05)、MACE的发生率(7.41%vs 23.08%,P<0.05)低于硝普钠组,LVEF高于硝普钠组[(58.2±6.3)%vs(50.4±9.7)%,P<0.05]。结论对于急诊PCI治疗术中出现无复流,应用替罗非班优于硝普钠,冠状动脉内注射替罗非班可以增加STEMI患者PCI术中发生无复流现象后冠状动脉血流和心肌组织灌注,减少术后心绞痛及MACE的发生率,改善远期预后。

Objective To compare the effect of intracoronary injection of tirofiban, a platelet glycoprotein （GP） IIb/ IIIa receptor antagonist, and sodium nitroprusside （SNP） on no-reflow during primary percutaneous coronary intervention （PCI） in patients with acute ST-segment elevation myocardial infarction （STEMI）. Methods A total of 106 STEMI patients underwent primary PCI with no-reflow phenomenon between February 2009 and October 2012 in our hospital were enrolled in this study. According to intracoronary different drugs therapy, the 106 patients were divided into tirofiban group （54 cases） and SNP group （52 cases）. After occurrence of no-reflow phenomenon, intracoronary injecting tirofiban was given in tirofiban group, while intracoronary bolus SNP was given in SNP group. The coronary angiographic infarct-related artery TIMI flow, the corrected TIMI frame count （cTFC）, the incidence of angina pectoris and major adverse cardiac events （MACE） 30 days after procedure and left ventricular ejection fraction （LVEF） were compared in two groups. Results Coronary angiography after intracoronary injecting drugs showed that the ratio of TIMI grade 3 in tirofiban group was higher than that in SNP group （62.96% vs 42. 35%, P 〈 0.01 ）. The cTFC in tirofiban group was less than that in SNP group [ （38.6 ± 7.2） vs （49.4 ±9. 5）, P 〈 0.01 ]. The incidences of angina pectoris and MACE 30 days after procedure in tirofiban group were lower than those in SNP group （5.56% vs 21.15%, P 〈0.05; 7.41% vs 23.08%, P 〈 0. 05 ）. LVEF in tirofiban group was higher than that in SNP group [ （ 58.2 ±6.3 ） % vs （ 50.4 ±9.7 ） %, P 〈 0. 05 ]. Conclusions Intracoronary injection of tirofiban is superior to intraeoronary injection of SNP for improving no-reflow after primary PCI in STEMI patients. Tirofiban therapy can increase coronary blood flow and myocardial perfusion after occurring of no-reflow phenomenon in primary PCI for STEMI patients and reduce incidence of angina and MACE as well as improve long-term prognosis, thereby it can yet be regarded as an optional srategy to treat noreflow.