替罗非班对急性ST段抬高型心肌梗死患者梗死相关动脉自发再通的影响

Effect of Tirofiban on the incidence of spontaneous reperfusion of infarct-related artery in patients with ST-segment elevated myocardial infarction

目的 探讨急性ST段抬高型心肌梗死（STEMI）行直接PCI患者上游应用替罗非班对梗死相关动脉自发再通的影响.方法 选择2008年10月至2012年10月本院STEMI行直接PCI患者488例,根据是否使用替罗非班分为替罗非班组（367例）和对照组（121例）.比较两组患者的临床基线特征、造影情况、心肌梗死溶栓治疗临床试验TIMI血流分级和PCI术前梗死相关动脉自发再通发生率.结果 两组患者临床基线特征、造影资料,手术情况比较差异均无统计学意义.梗死相关动脉自发再通发生率替罗非班组明显高于对照组[135例（36.78％）比21例（17.36％）,P＜0.01].Spearman双变量相关分析显示,替罗非班的使用和自发再通两者呈明显正相关（相关系数r=0.180,P＜0.01）.Logistic多因素回归分析显示,使用替罗非班是自发再通的独立预测因素（OR=3.10,95％ CI 1.81～5.31,P＜0.01）.结论 急性STEMI行直接PCI患者上游应用替罗非班可以提高梗死相关动脉自发再通发生率.

Objective To investigate the effect of upstream administration of platelet glycoprotein Ⅱ b/Ⅲ a receptor inhibitor （GPI） Tirofiban on the incidence of spontaneous reperfusion （SR） of infarct-related artery in patients who were treated by primary percutaneous coronary intervention（PCI） with ST-segment elevated myocardial infarction（STEMI）.Methods From Oct 2008 to Oct 2012,a total of 488 consecutive patients undergoing primary PCI for STEMI were selected.According to the presence or absence of Tirofiban administration,all subjects were divided into 2 groups：Tirofiban group（n=367） and control group（n=121）.Clinical data,including baseline clinical characteristics,angiographic features,anterograde flow,Thrombolysis In Myocardial Infarction （TIMI） grade and incidence of SR of IRA were recorded.Results There were no significant differences between the two groups in basic clinical baseline characteristics,angiographic features before PCI （P〉0.05）.The incidence of SR of Tirofiban group was higher than that of control group [135（36.78%） vs 21（17.36%）,P〈0.01].By Spearman correlation analysis,the administration of Tirofiban was significantly correlated with the incidence of SR（r=0.180,P〈0.01）.Using multivariate logistic regression analysis,use of Tirofiban（OR=3.10,95% CI 1.81-5.31,P〈0.01） independently predicted the occurrence of SR.Conclusion Upstream administration of Tirofiban improves the incidence of SR of infarct-related artery in patients who were treated by primary PCI with STEMI.