超选择冠脉内注射替罗非班联合血栓抽吸对急性ST段抬高型心肌梗死患者心肌灌注的影响

Impact of selective infarct-related artery infusion of Tirofiban on myocardial reperfusion in patients with acute ST-segment elevation myocardial infarction

目的探讨急性sT段抬高型心肌梗死（STEMI）患者直接经皮冠状动脉超选择注射盐酸替罗非班及联合血栓抽吸对心肌灌注的影响。方法选择2014年3月至2015年8月粤北人民医院STEMI患者210例，随机分为试验组（n=110）和对照组（n=100）。所有入选患者均在发病12h内进行经皮冠状动脉介入治疗（PCI）。对照组冠脉口注射替罗非班后进行血栓抽吸，再放置药物支架；试验组通过抽吸导管超选择冠脉闭塞处注射替罗非班后进行血栓抽吸，再放置药物支架。主要观察指标为PCI术后即刻造影结果（TIMI帧数）、术后90min完全sT段回落率、肌酸激酶同工酶（CK—MB）和肌钙蛋白I（cTnI）峰值、cTnI峰值时间及住院期间主要心脏不良事件和出血风险。结果两组患者基线特征未见统计学差异。试验组与对照组术后校正的TIMI帧数分别是[（29．25±10．22）s比（37．46±11．32）s，P=0．046]，术后90min完全ST段回落率分别是188（80％）比67（67％），P=0．091]，CK-MB峰值分别是[（380．68±298．41）U／L比（425．33±317．62）U/L，P=0．202]，eTnI峰值分别是[（12．31±10．08）ng／ml比（15．18±10．89）ng／ml，P=0．191]，cTnI峰值时间分别是[（17．25±10．72）h比（19．01±11．22）h，P=0．277]，可见试验组在数据上比对照组有着更好的趋势。实验组与对照组患者住院期间主要心脏不良事件发生率分别为[22（20％）比18（18％），P=0．954]，出血事件发生率分别为[14（13％）比11（11％），P=0．926]，未见统计学差异。结论超选择冠脉内注射替罗非班联合血栓抽吸相比冠脉口注射替罗非班联合血栓抽吸可能更好改善STEMI患者PCI术后早期心肌灌注水平。

Objective To investigate the impact of selective infarct-related artery infusion of Tirofiban on myocardial reperfusion in patients with acute ST-segment elevation myocardial infarction （STEMI）. Methods A total of 210 consecutive STEMI patients within 12 hours of symptom onset were randomly assigned to receive Tirofiban through aspiration catheter （experimental group, n = 110 ） or guiding catheter （control group, n = 100） be- fore thrombus aspiration, all the patients finally performed PCI. The primary endpoint was the corrected thrombolyt- ic in myocardial infarction（TIMl） frame count（CTFC ） after the procedure, complete ST-segment elevation resolu-tion（ 〉70% ） at 90 minutes after angioplasty and the peak of creatine kinase-MB（CK-MB） and troponin I（cTnI ）, as well as the major adverse cardiac events in the hospital and any bleeding events. Results Baseline characteris- tics of the two groups were well-balanced. The CTFC[ （29.25±10.22）s vs. （37.46±11.32）s, P=0.046] was superi- or in experimental group than control group. There was no significant statistical difference between two group in the complete ST-segment elevation resolution（80% vs. 67%, P=0.091 ）, the peak of CK-MB[（380.68±298.41 ）U/L vs. （425.33±317.62）U/L, P=0.202 ] and the peak of eTnI [ （ 12.31 ±10.08）ng/ml vs. （ 15.18±10.89）ng/ml, P= 0.191], as well as the peak time of cTnI [（17.25±10.72）h vs. （19.01±11.22）h, P=0.277]. The major adverse cardiac events in the hospital（20% vs. 18%, P=0.954） and any bleeding events（13% vs. 11%, P=0.926） had no significant statistical difference between experimental group and control group. Conclusion Thromhus aspiration plus infarct-related artery infusion of Tirofiban in patients with STEMI undergoing primary angioplasty may improve myocardium perfusion.