替格瑞洛联合替罗非班在急诊经皮冠状动脉介入治疗中的近期疗效

Short-term curative effect of ticagrelor combining tirofiban during emergency percutaneous coronary intervention

目的观察替格瑞洛联合替罗非班在急性ST段抬高型心肌梗死(STEMI)患者行急诊经皮冠状动脉介入治疗(PCI)中的近期疗效。方法选取2013年6月至2014年6月期间在邢台市第三医院心内科诊断为STEMI并行急诊PCI患者共105例,其中男性60例,女性45例,平均年龄(57.8±10.1)岁。入选者随机分为2组,对照组(50例)和试验组(55例)。对照组应用替格瑞洛并行急诊PCI,试验组在对照组基础上加用替罗非班。比较两组患者术后TIMI血流分级、心肌灌注及无复流发生率,术后3个月的心功能及左室舒张末期内径,记录住院期间和术后3个月内的主要不良心血管事件(MACEs)、出血事件等。结果与对照组比较,试验组TIMI血流3级比例、术后ST段回落>75%比例增加,无复流比例降低,(78.0%vs.92.7%)、(50.0%vs.78.2%)、(16.0%vs.1.8%),差异有统计学意义(P均<0.05)。对照组大出血3例(6.0%)、轻度出血3例(6.0%)、不明显出血44例(88.0%);试验组大出血1例(1.8%)、轻度出血11例(20.0%)、不明显出血43例(78.2%);两组出血事件发生率差异无统计学意义(P>0.05)。试验组较对照组发病3个月内主要不良心血管事件、左室舒张末期内径降低,左室射血分数增加,(3.6%vs.18%)、[(46.5±4.7)mm vs.(48.8±5.7mm)]、[(57.9±5.1)%vs.(55.1±6.1)%)],差异有统计学意义(P均<0.05)。结论替格瑞洛联合替罗非班在改善急性心肌梗死行急诊PCI患者心肌灌注,保护心脏功能,不增加患者出血风险方面优于替格瑞洛单药治疗。

Objective To observe the short-term curative effect of ticagrelor combining tirofiban during emergency percutaneous coronary intervention（PCI） in patients with acute ST-segment elevation myocardial infarction（STEMI）. Methods The patients with STEMI undergone PCI（n=105, male 60, female 45 and average age=57.8±10.1） were chosen from Jun. 2013 to Jun. 2014. All patients were randomly divided into control group（n=50） and test group（n=55）, and 2 groups were given ticagrelor and emergency PCI and test group was additionally given tirofiban. TIMI grading, incidence of myocardial perfusion and no reflow after PCI and heart function and LVESd after PCI for 3 m were compared in 2 groups, and major adverse cardiovascular events（MACE） and bleeding events were recorded during hospitalization and after PCI for 3 m. Results Compared with control group, the percentage of patients with grade 3 of TIMI and percentage of patients with ST-segment resolution75% increased, and percentage of patients with no reflow decreased in test group after PCI [（78.0% vs. 92.7%）,（50.0% vs. 78.2%）,（16.0% vs. 1.8%）, all P〈0.05]. There were 3 patients（6.0%） with serious bleeding, 3（6.0%） with hyporrhea and 44（88.0%） with mild bleeding in control group, and there were 1 patient（1.8%） with serious bleeding, 11（20.0%） with hyporrhea and 43（78.2%） with mild bleeding in test group（P〉0.05）. The incidence of MACE decreased, LVESd decreased and LVEF increased [（3.6% vs. 18%）,（46.5±4.7） mm vs.（48.8±5.7mm）,（57.9±5.1） % vs.（55.1±6.1） %）] in test group compared with control group within 3 m after disease attack（all P〈0.05）. Conclusion Ticagrelor combining tirofiban is better than only ticagrelor therapy in improving myocardial perfusion, protecting heart function and non-increasing bleeding risk in patients with acute myocardial infarction undergone PCI.