血栓抽吸联合梗死相关动脉内注射替罗非班在ST段抬高型心肌梗死延迟PCI术中的临床研究

Effect of Thrombus Aspiration and Intracoronary Injection of Tirofiban in Delay Percutaneous Coronary Intervention with ST-segment Elevation Myocardial Infarction

目的探讨血栓抽吸联合梗死相关动脉内注射盐酸替罗非班在处理接受延迟PCI术的急性ST段抬高型心肌梗死患者的有效性及安全性。方法将急性ST段抬高型心肌梗死患者240例,按随机数字表法分为2组,传统PCI术组120例接受传统PCI术治疗,血检抽吸联合PCI术组120例,接受血栓抽吸联合梗死相关动脉内注射盐酸替罗非班治疗。比较2组患者临床特征、梗死相关冠脉的开通率、PCI术成功率、出血并发症发生率、住院时间、住院费用、住院期间死亡率、住院期间不稳定性心绞痛发生率、再梗或严重脑卒中发生率、心力衰竭发生率、复合终点事件发生率(不稳定性心绞痛、再梗或严重脑卒中、心力衰竭),并对所有患者进行为期6个月的随访。结果 2组患者临床及冠脉造影特征比较差异无统计学意义(P>0.05)。血栓抽吸联合PCI术组与传统PCI术相比,梗死相关冠脉开通率更高(98%比92%,P=0.03),住院期间不稳定性心绞痛发生率更低(4.8%比6.4%,P=0.03)、复合终点发生率更低(13.9%比16.2%,P=0.03);术后6个月随访期间不稳定性心绞痛发生率更低(4.6%比5.8%,P=0.03)、心力衰竭发生率更低(6.8%比7.6%,P=0.03)、复合终点发生率更低(14.6%比16.8%,P=0.05)。结论血栓抽吸联合PCI术能减少接受延迟PCI术的STEMI患者住院期间及术后6个月不稳定性心绞痛及复合终点事件发生率,减少术后6个月心衰发生率,更好地保护残存的心肌,改善患者的心功能。

Objective To compare the effectiveness and safeness between Thrombus aspiration unite PCI（PCI ＋ thrombus aspiration ＋ Intracoronary injection of Tirofiban） and Classical PCI（PCI ＋Intracoronary injection of Tirofiban） in delay percutaneous coronary intervention with ST-segment elevation myocardial infarction patients. Methods This is a consecutive,randomized,open-label study.Consecutive patients with STEMI whose attack to door time was more than 12 hours and did not undergo thrombolysis were enrolled into the study. All patients were randomized classified to 2 groups,they were assigned to receive Classical PCI and Thrombus aspiration unite PCI respectively. We compare the clinical characteristcs, proportion of TIMI-3 after procedure, success rate of PCI, bleed rate, inpatient days, hospitalization costs, mortality during hospitalization, unstable angina/re-infarction or serious stroke/heart failure rate and the composite adverse events rate of the two groups. Results 240 patients enrolled into the study, 120 patients in every group.There were no statistical differences between the two group in clinical characteristcs（P〈0.05）.Patients in the Thrombus aspiration unite PCI group, compared with those in the classical PCI group, were characterized by higher proportion of TIMI-3 after procedure（98% vs 92%,P =0.03）, lower rate of unstable angina（4.8% vs 6.4%,P =0.03） and composite adverse events（13.9% vs 16.2%,P=0.03）during hospitalization, lower rate of unstable angina（4.6% vs 5.8%,P=0.03）, heart failure（6.8% vs 7.6%,P=0.03）and composite adverse events（14.6% vs16.8%,P =0.05） within 6-month follow-up.Conclusion Comparing with classical PCI, Thrombus aspiration unite PCI has the potential to reduce the rateof unstable angina and composite adverse events during hospitalization and within 6-month follow-up, to reduce the rate of heart failure within 6-month follow-up in STEMI patient who undergo delay PCI. Besides, it has the potential to protect the relict myocardium, to improve patient＇s heart fuction.