不同时机冠脉内注射替罗非班联合血栓抽吸对STEMI心肌灌注和预后的影响

The impact of myocardial perfusion and prognosis of intracoronary injection of Tirofiban at different time combine with thrombus aspiration in patients with acute STEMI undergoing percutaneous coronary intervention

目的探讨急性ST段抬高型心肌梗死(STEMI)经皮冠状动脉介入治疗(PCI)术中不同时机冠状动脉内注射替罗非班联合血栓抽吸对心肌灌注和近期临床预后的影响。方法选取行急诊PCI的STEMI患者120例,随机分为A组、B组和C组,A组在行血栓抽吸前经由抽吸导管冠脉内注入替罗非班10μg/kg,然后行血栓抽吸,随后根据病变特点行PCI并植入雷帕霉素药物洗脱支架;B组先行血栓抽吸,抽吸后经由血栓抽吸导管冠脉内注入替罗非班10μg/kg,然后根据病变特点行PCI并植入雷帕霉素药物洗脱支架;C组先经由血栓抽吸导管冠脉内注入替罗非班10μg/kg,然后行血栓抽吸,血栓抽吸后再次冠脉内注入替罗非班10μg/kg,最后根据病变特点行PCI并植入支架。比较3组PCI术中即刻心肌梗死溶栓试验(TIMI)血流分级、心肌灌注(TMP)分级、术后90 min ST段回落情况、肌酸激酶同工酶(CK-MB)和肌钙蛋白I(TNI)峰值,左心室射血分数,住院期间和随访主要不良心血管事件(MACE,包括支架内血栓形成、非致命性再梗死、靶血管血运重建、心衰加重、死亡等)发生率,出血事件发生率。结果 3组患者临床基本情况差异无统计学意义;A组、B组比较,术后TIMI血流、TMP分级、ST段回落幅度、CKMB峰值、肌钙蛋白I峰值、左心室射血分数,比较差异无统计学意义;C组与A组、B组比较差异有统计学意义(P<0.05);3组间出血事件发生率、MACE差异无统计学意义。结论 STEMI急诊PCI术中血栓抽吸前和抽吸后冠状动脉内注射替罗非班,可改善心肌灌注,出血发生率无明显增加。

Objective To investigate the impact of intracoronary injection of Tirofiban through thrombus aspiration catheter before and after or both combine with thrombus aspiration in patients with acute ST-segment elevation myocardial infarction（STEMI） undergoing percutaneous coronary intervention（PCI）. Methods 120 patients of STEMI undergoing primary PCI were randomly assigned to intracoronary Tirofiban before thrombus aspiration group（A group）,intracoronary Tirofiban after thrombus aspiration group（B group）, and both with thrombus aspiration group（C group）;Tirofiban 10 μg/kg intracoronary bolus was administered before thrombus aspiration, or after thrombus aspiration, or before and after thrombus aspiration. Thrombolysis in myocardial infarction（TIMI）,TIMI myocardial perfusion grade（TMP）, elevated ST segment resolution rate（STR） at 90 minutes after PCI, the peak of creatine kinase-MB（CK-MB） and troponin I（Tn I） after PCI, left ventricular ejection fraction（LVEF）, major adverse cardiovascular events（MACE） and ratios of bleeding within three months after PCI among 3 group were compared. Results The rate of TIMI flow grade3, the rate of TMP grade3, the rate of ST-segment resolution50%, The peak of CK-MB and Tn I, were similar between the A group and B group;significantly lower in the C group than with the A group or B group（P〈0.05）; LVEF were similar between the A group and B group, were significantly higher in the C group than in the A group or B group（P〈0.05）; Bleeding events were similar along the 3 groups.The MACE rate at 1 to 3month follow-up were similar along the 3 group. Conclusion Intracoronary injection Tirofiban before and after thrombus aspiration were effectual and safe in patients with STEMI undergoing PCI, It may improve myocardial perfusion, without increasing bleeding complication.