PCI术前应用替罗非班对ACS患者的疗效和安全性研究

Safety and efficacy of tirofiban before PCI for acute coronary syndrome

目的探讨PCI术前应用替罗非班对急性冠脉综合征患者介入治疗的疗效和安全性及临床使用替罗非班的最佳时机。方法观察三组血小板聚集率（PAR）、PCI术前后肌酸激酶同工酶（CK-MB）及TIMI血流情况，7d、30d及90d厦主要心脏不良事件（MACE、死亡、再次心肌梗死和复发心肌缺血）、急性血栓事件和出血事件与血小板减少症的发生率。结果应用替罗非班（PCI术前应用和PCI术后即刻应用）显著降低了术后24hCK-MB水平的升高，较未应用组差异有统计学意义（10．30±1．49VS13．30±1．49VS17．50±3．24，P=0．001）。PCI术前应用组与PCI术后即刻应用组和未应用组相比，术前靶血管的TIMI3级血流的获得率明显较高（51．2％vs 29．1％ vs 34．3％，P=0．028）。三组PCI术后7d、30d及90dMACE事件发生率比较差异均无统计学意义，但PCI术前应用组较其他两组的发生率低。三组无GUSTO重度和中度出血的发生，轻度出血与血小板减少症的发生率比较差异也无统计学意义。结论PCI术前应用替罗非班可有效地抑制中高危急性冠脉综合征患者血小板的聚集水平，改善PCI术前TIMI血流、减少术后心肌损伤和急性血栓事件的发生，并有进一步降低术后MACE发生率的趋势。

Objective To observe the safety and efficacy of tirofiban before PCI for acute coro- nary syridrome, and the best time of tirofiban in clinics. Methods The platelet aggregation rate （PAR）, MB isoenzyme of creatine kinase （CK-MB） and TIMI 3 flow rate before and after PCI, inci- dences of 7-day, 30-day and 90-day major adverse cardiac events （ MACE, death, reinfarction, recurrent myocardial ischemia）, acute thrombotic events, bleeding complications and thrombocytopenia were recor-ded. Results Application of tirofiban （applications before PCI and applications immediately after PCI ） significantly reduced MB isoenzyme of creatine kinase after PCI 24hours（ 10.30 ± 1.49 vs 13.30± 1.49 vs 17.50± 3.24 ,P =0. 001 ）. Before PCI, TIMI 3 flow rate of the target vessel was significantly higher in tirofiban before PCI group than that in downstream tirofiban and no tirofiban groups （51.2% vs 29. 1% vs 34. 3%, P =0. 028）. There was no significant difference a- mong the three groups in the 7-day, 30-day and 90-day occurrences of MACE, through the incidences were consistently lower in tirofiban before PCI. No GUSTO severe or moderate bleeding was observed. The incidences of slight bleeding complications and thrombocytopenia were not significantly different a- mong the three groups. Conclusions Tirofiban let aggregation, a better patency （TIMI 3 flow） lower occurrence of acute thrombosis events and before PCI is associated with potently inhibition of plate- before PCI, attenuated minor myocardial damage, the the tendency of reducing incidences of MACE.