血栓抽吸联合冠脉内注入替罗非班预防急诊PCI术中无复流

Effect of thrombus aspiration combined with intracoronary tirofiban to prevent no-reflow phenomenon in percutaneous coronary intervention for acute myocardial infarction

目的评价急性ST段抬高心肌梗死(STEAMI)患者急诊行经皮冠脉内支架植入术(PCI)中应用血栓抽吸联合替罗非班预防无复流的有效性和安全性。方法选择符合条件的STEAMI患者156例,随机分为研究组(81例)和对照组(75例),在常规应用抗凝、抗血小板基础上,研究组PCI术中采用血栓抽吸联合冠脉内注入替罗非班。对照组直接行PCI。记录两组术中无复流发生率,PCI术后90 min临床症状和心电改善情况,出血风险及1年内主要心脏不良事件(MACE)发生率。结果术前两组临床症状、冠脉病变特征等无明显差异(P>0.05)。与对照组相比,研究组无复流明显减少,临床症状明显改善,心电图ST段明显回落,随访1年MACE发生率明显减少(P均<0.05)。两组出血事件无明显差异(P>0.05)。结论血栓抽吸联合冠脉内注入替罗非班可显著降低STEAMI患者行急诊PCI术中无复流的发生,减少主要心脏不良事件,是安全有效的。

Objective To investigate the safety and efficacy of thrombus aspiration combined with intracoronary tirofiban to prevent no-reflow phenomenon in patients with acute ST elevation myocardial infarction （STEAMI） treated with primary percutaneous coronary intervention （PCI）. Methods A total of 156 STEAMI patients received PCI were enrolled and randomly divided into treatment group 81 cases and contrast group 75 cases. Patients of treatment group were assigned to receive aspiration thrombectomy catheter combined with injection of tirofiban in coronary artery. But patients of contrast group who had similar coronary angiography results and basic characteristics only received routine PCI. Clinical symptoms, ECG record of 90 minutes after PCI, angiographic features （coronary arteries blood flow TIMI grade and TIMI myocardial perfusion TMP ）, the incidence of no-reflow, bleeding risk and major adverse cardiac event （MACE） within I year between two groups were analyzed. Results There were no significant difference in baseline characteristics before PCI between two groups （P〉0.05）. Compared with the contrast group, there were less no-reflow or slow flow phenomenon, significantly improvement in clinical symptoms, significantly dropped EGG ST-segment and less MACE within 1 year in the treatment group（ all P〈0.05 ）. There were similar serious bleeding risk between two groups （P〉0.05）. Conclusions Application of thrombus aspiration combined with intracoronary tirofiban in patients with STEAMI treated with PCI is safe and effective, which can effectively prevent no-reflow phenomenon and significantly decrease MACE.