STEMI介入治疗患者急诊提前应用替罗非班的效果及安全性

Effect and safety of preoperative emergency application tirofiban on percutaneous coronary intervention in STEMI patients

目的:探讨急性ST段抬高心肌梗死(STEMI)患者行急诊经皮冠状动脉介入治疗(PCI)前应用替罗非班的疗效及安全性。方法:选择2012年12月至2013年12月我院STEMI接受急诊PCI联合应用替罗非班的患者147例,按照随机数字表法分为急诊替罗非班组(76例,在急诊PCI前开始应用替罗非班)和常规替罗非班组(71例,常规术后使用替罗非班)。比较术前、术后梗死相关血管血流情况、临床出血并发症及术后30d内心血管事件发生率。结果:与常规替罗非班组比较,急诊替罗非班组术前TIMI3级(10.0%比22.4%)与TIMI2级+TIMI3级(23.9%比39.5%)血流比例明显升高(P均<0.05);两组术后TIMI3级血流比例、Blush3级和TIMI计帧数获得率均无显著差异(P均>0.05);临床出血并发症及术后30d内心血管事件发生率差异无统计学意义(P>0.05)。结论:急诊提前应用替罗非班可提高ST段抬高心肌梗死患者PCI前梗死相关血管前向血流。

Objective： To explore therapeutic effect and safety of preoperative emergency application tirofiban on per- cutaneous coronary intervention （PCI） in patients with acute ST elevation myocardial infarction （STEMI）. Methods： A total of 147 STEMI patients, who received emergency PCI combined tirofiban in our hospital from Dec 2012 to Dec 2013, were selected. According to random number table method, they were divided into emergency tirofiban group （n = 76, receive tirofiban before PCI） and routine tirofiban group （n = 71, received tirofiban after PCI as rou- tine）. Preoperative antegrade blood flow in infarct related vessels, postoperative blood flow, incidence rates of clin- ical bleeding complications and cardiovascular events within 30d after PCI were compared between two groups. Re- sults： Compared with routine tirofiban group, before PCI, there were significant rise in percentages of TIM! blood flow class 3 （10. 0% vs. 22.4%） and class 2 ＋ 3 （23.9% vs. 39.5%） in emergency tirofiban group, P^0.05 all~ there were no significant difference in postoperative TIMI blood flow class 3, Blush class 3, TIMI frame count and incidence rates of clinical bleeding complications and cardiovascular events within 30d after PCI between two groups, P〉0.05 all. Conclusion： Preoperative emergency application tirofiban can improve antegrade blood flow in infarct related vessels before PCI in STEMI patients .