女性急性冠脉综合征患者介入治疗围术期应用替罗非班的安全性研究

EFFICACY AND SAFETY OF TIROFIBAN FOR FEMALE PATIENTS WITH ACUTE CORONARY SYNDROMES IN PERIOPERATIVE PERIOD OF PERCUTANEOUS CORONARY INTERVENTION

目的 探究介入治疗围术期联合应用替罗非班强化抗血小板对不同性别急性冠脉综合征（ACS）患者的有效性及安全性。方法 回顾性收集解放军总医院心血管内科2011年1月—2013年12月确诊为ACS,并植入药物洗脱支架（DES）,且围术期均应用小剂量替罗非班的患者441例（年龄35~90岁）,根据性别分为男性组（n=235）,女性组（n=206）。比较二组患者PCI术后30d内主要及次要终点事件的发生率,应用多因素Logistic回归分析终点事件发生的相关危险因素。结果 1女性组主要终点事件的发生率明显高于男性组[30例（14.7%）vs15例（6.4%）;P=0.005],而30d内MACCE的发生率[13例（6.3%）]与男性组[8例（3.4%）]相比有增高趋势,但差异无统计学意义（P=0.153）。2二组患者在随访期间均未出现严重的颅内出血,消化道出血二组各1例,而女性组轻微出血事件的发生率较高[33例（16.0%）vs15例（6.4%）;P=0.001]。3Logistic回归分析表明,年龄≥65岁、吸烟史、糖尿病、高脂血症、既往PCI史及节段性室壁运动异常是30d内主要终点事件的独立危险因素。结论 女性ACS患者术后30d主要终点事件及轻微出血事件发生的概率都比男性高,而二组患者MACCE事件的发生差异无统计学意义,提示女性接受PCI治疗时强化抗血小板的获益与出血风险之间的权衡应慎重。

Objective To assess the efficacy and safety on different gender patients suffered from acute coronary syndromes{ACS）by the combined application of tirofiban to intense the antiplatelet therapy in perioperative period. Methods This retrospective study recruited the data of 441 （aged from 38 to 87} consecu- tively patients who were diagnosed as acute coronary syndromes, given low- dose tirofiban in perioperative period, received pereutaneous coronary intervention and implanted drugeluting stents（DES} in author＇s hospital from Jan. 2011 to Dec. 2013. They were divided into two groups： the male group （n = 235） and the female group（n = 206}. The primary＇and the secondary endpoints events were compared within 30 days perioperative period between the two groups, and the risk factors of the endpoints were analyzed though multiple factor Logistic regression analysis. The main endpoints events included stent thrombosis （ST）, major adverse cardiac and cerebrovascular events（MACCE）, instent restenosis and recurrent angina pectoris. Results The primary endpoint （30114.7%3vs1516.4}/00] ;P = 0. 005）of the female group significantly highter than that of the male group. The incidence rate of MACCE in female group, compared to male group, had an increased trend within 30 days, but it was no statistical significance（P = 0. 153/. No serious acute intracranial bleeding events occur in the two groups, only one of them of gastrointestinal bleeding e- vents was in each group, but the minimal bleeding events of female group were higher than that of male group（33[16.0M＇lvsl5[6.4%];P = 0. 001）. Multiple factor Logistic regression analysis manifested that aged over 65 years, history of smoking, diabetes mellitus, hyperlipidemia, prior history of PCI and regional wall motion abnormality（RWMA） were independent risk factors of the primary endpoint in two groups during 30- day follow up. Conclusions The incidence rate of primary endpoint and minimal：bleeding e- vents occurred in the female group are both higher than that of the male group after the ACS within 30 days, while the incidence rate of MACCE in the two groups has no significant difference, which suggests that female patients should prudently weigh the benefits of intensity of antiplatelet therapy and the risks of bleeding when received the PCI treatment.