直接经皮腔内冠状动脉介入治疗术前应用替罗非班对ST段抬高型心肌梗死患者无/慢复流的影响

Curative effect of applying tirofiban before primary percutaneons coronary interventin in patients with ST segment elevation myocardial infarction suffering no/slow reflow phenomenon

目的探讨直接经皮腔内冠状动脉介入治疗(PCI)术前应用替罗非班对ST段抬高型心肌梗死(STEMI)患者无/慢复流的影响及安全性。方法行直接PCI术并且静脉应用替罗非班的STEMI患者296例,根据替罗非班的用药时机分为术前用药组和术中用药组。分析两组术前与术后梗死相关动脉(IRA)血流情况,术后左心室射血分数(LVEF),住院期间主要不良心血管事件(MACE)、出血及严重的血小板减少症的发生率。结果术前用药组PCI术前及术后IRA前向血流达到心肌梗死溶栓治疗(TIMI)3级比例均高于术中用药组,分别为(74.7%vs47.2%、98.9%vs 93.2%,P<0.05)。术前用药组PCI术后LVEF高于术中用药组(58.31±5.35)%vs(52.93±6.01)%(P<0.05)。两组术后住院期间MACE、出血及严重的血小板减低症发生率相比较,差异无统计学意义。结论术前应用替罗非班可以减少无复流及慢复流发生率,保护心脏功能;此外,术前应用替罗非班不增加STEMI患者PCI术后出血等严重不良反应发生率。

Objective To investigate the curative effect and the security of applying tirofiban before primary percutaneous coronary intervention （PCI） in patients with ST segment elevation myocardial infarction （STEMI） suffering no/slow reflow phenomenon. Methods A total of 296 patients with STEMI were selected into this study. All patients underwent primary PCI and applied tirofiban by intravenous route. According to the different mediction time of the tirofiban, all patients were divided into preoperative treatment group and intraoperative treatment group. Blood flow condition of the infarction related artery （IRA） of preoperation and postoperation, postoperative left ventricular ejection fraction （LVEF）, the incidence of major adverse cardiovascular events （MACE） bleeding and serious thrombopenia （PLT〈10× 10^9/L） during hospitalization were analysed in both groups. Results The ratio of TIMI 3 of IRA in preoperative treatment group was significantly higher than those of intraoperative treatment group in preoperation （74.7% vs 47.2%, P 〈0.05） and postoperation （98.9% vs 93.2%, P 〈0.05）. The postoperative left ventricular ejection fraction was significantly higher in preoperative treatment group than in intraoperative treatment group （58.31± 5.35） % vs （52.93 ± 6.01） % （ p 〈 0.05）. There were no significant difference in the incidence of MACE, bleeding and serious thrombopenia during hospitalization in both groups. Conclusion Preoperative tirofiban treatment can reduce the incidence of no and slow reflow phenomenon and protect the heart function, additionally, preoperative tirofiban does not increase the incidence of postoperative bleeding in patients with STEMI.