冠状动脉内联合注射替罗非班和山莨菪碱对ST段抬高心肌梗死患者溶栓早期PCI心肌灌注改善作用的评价

Additive benefit of glycoprotein Ⅱb/Ⅲa inhibition and adjunctive anisodamine during early coronary intervention following thrombolysis on myocardial perfusion in patients with ST-segment elevation myocardial infarction

尽早、充分、持久开通梗死相关动脉(infarctionrelated artery,IRA),保护左室功能,减少心肌梗死面积,是降低ST段抬高心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者死亡率、改善临床预后的关键^([1])。溶栓和直接经皮冠状动脉介入治疗(primary percutaneous coronary in tervention,PCI)作为STEMI再灌注治疗的主要方法,具有备自的优势和不足^([2])。近期研究表明,对于首诊于无PCI条件医院的STEMI患者。

Consecutive STEMI patients undergoing early PCI within 24 h of thrombolysis and admitted from December 2010 to December 2011 were randomly assigned to 4 groups：primary PCI group（PCI group）,anisodsamine infusion group（ANI group）,tirofiban infusion group（TIR group） and PCI with both treatments group（ANI＋TIR group）.PCI was performed according to the result of CAG.After coronary angiography,but before the first balloon inflation,patients in the ANI group and TIR＋ ANI group received intracoronary bolus injection of anisodamine,and the same vulome of 0.9%sodium chloride in the other two groups.Tirofiban was administered in TIR group and ANI＋TIR group and the same vulome of 0.9%sodium chloride in the remaining patients.TIMI flow grade（TFG）,corrected TIMI frame count（CTFC）,TIMI myocardial perfusion grade（TMPG） and thrombosis score before and after PCI were recorded.Serum creatine kinase（CK）,MB fraction（CK-MB）,and standard 12-lead ECGs were recorded at admission.Echocardiographic examination was performed at discharge by a cardiologist blinded to the randomization results.The occurrence of MACE was compared among the groups.There was a trend of more patients achieving post-procedural TIMI 3 flow in the ANI ＋ TIR group,compared to the primary PCI group（95.8%vs.75.0%,P = 0.084）.The post-procedural CTFC in ANI＋TIR group was less than the other three groups（P = 0.002）,while the post-procedural CTFC in both ANI group and TIR group were improved.There was also a possible interaction regarding CTFC with the P = 0.765 of anisodamine ＋ tirofiban.There was a trend of more complete STR in both ANI group and TIR group than that in primary PCI group,and a significant difference of more complete STR in ANI＋TIR group was found than that in primary PCI group（91.7%vs.58.3%,P = 0.039）.There was a trend of high level of peak CK-MB in primary PCI group（P = 0.245）.No significant difference of bleeding complications was found among groups.There was a trend of higher LVEF at discharge in the TIR＋ANI group,compared to the primary PCI group[（56.19%±4.05%） vs.（50.70%±7.35%）,P = 0.005）].No significant difference of occurrence of MACE was found among groups（P = 0.686）.