急性ST段抬高型心肌梗死围术期替罗非班不同方法给药的疗效和安全性

Safety and efficacy of tirofiban used different methods in patients with ST-segment elevation myocardial infarction during perioperative period

目的评价经静脉和经冠状动脉内给予负荷剂量替罗非班注射液两种不同给药方式对ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者直接经皮冠状动脉介入(percutaneous coronary artery intervention,PCI)治疗的有效性和安全性。方法 82例行直接PCI治疗的STEMI患者,按随机数字表法随机分为上游组42例(术前急诊室早期静脉使用替罗非班)和下游组40例(术中导管室经冠状动脉使用替罗非班),比较两组基础临床情况、介入治疗后结果、住院期间出血并发症、30 d主要不良心血管事件(心绞痛,再发心肌梗死,心源性死亡)发生率及左心室射血分数。结果两组基础临床情况比较,差异无统计学意义(P>0.05)。与下游组比较,上游组有较高的梗死相关动脉PCI治疗后即刻心肌梗死溶栓试验(thrombolysis in myocardial infarction,TIMI)3级血流获得率,差异有统计学意义(85.7%vs.57.5%,P<0.05)。上游组术后30 d左心室射血分数显著高于下游组,且差异有统计学意义(53.0%±7.1%vs.44.0%±5.4%,P=0.01)。两组术后出血并发症、30 d主要不良心血管事件发生率比较,差异无统计学意义(P>0.05)。结论 STEMI患者行直接PCI治疗前早期静脉应用替罗非班可有效提高血管开通率、改善组织灌注和心功能。

Objectives To evaluate the safety and efficacy of two different ways of loading-dose tirofiban injection in patients with acute ST-segment elevation myocardial infarction（STEMI）treated with emergency percutaneous coronary intervention（PCI）by vein and coronary artery. Methods Totally 82 patients with STEMI treated with primary PCI were randomly allocated to either early administration of tirofiban in emergency room（early group,n=42）or later administration in catheter laboratory（later group,n=40）. Baseline characteristics and PCI features were compared between the two groups,as well as bleeding complications and left ventricular ejection fraction（LVEF）and major adverse cardiac events ocurrence rate（angina pectoris,re-infarction,death）during 30 days after PCI. Results Clinical characteristics were comparable between the two groups（P〉0.05）. Rate of thrombolysis in myocardial infarction（TIMI）blood flow grade 3 of infarcted related artery after PCI was higher in early group than in later group（85.7 % vs.57.5%,P〈0.05）. Early group had higher LVEF comparing with later group（53.0%±7.1% vs. 44.0%±5.4%,P=0.01）.There were no significant differences of bleeding complications incidence and major adverse cardiac events incidence between the two groups（P〉0.05）. Conclusions Early pre-interventional tirofiban therapy for patients with acute STEMI who undergo primary PCI improves patency of infarct-related artery,tissue reperfusion,and heart function.