摘要
背景:ST段抬高型心肌梗死(STEMI)患者行直接经皮冠状动脉介入(PCI)术前心外膜血流的早期恢复常伴有较好的临床预后。方法:设想,与在心脏导管室(CCL)行诊断性血管造影后使用血小板糖蛋白IIb/IIIa受体拮抗剂依替巴肽相比较,行PCI术前在急诊科(ED)早期使用依替巴肽可获得更好的心外膜血流和心肌灌注。343例STEMI患者被随机分为两组,分别于ED早期(n=180)或CCL(n=163)应用依替巴肽。
Background: Early restoration of epicardial flow before primary percutaneous coronary intervention(PCI) for ST-segment elevation myocardial infarction(STEMI) has been associated with improved clinical outcomes. Methods: We hypothesized that early administration of the glycoprotein IIb/IIIa inhibitor eptifibatide in the emergency department(ED) would yield superior epicardial flow and myocardial perfusion before primary PCI compared with initiating eptifibatide after diagnostic angiography in the cardiac catheterization laboratory(CCL). Three hundred forty-three patients with STEMI were randomized to either early ED eptifibatide(n=180) or CCL eptifibatide(n=163). Results: The primary end point(pre-PCI corrected TIMI frame count) was significantly lower(faster flow) with early eptifibatide(77.5±32.2 vs 84.3±30.7, P=.049). The incidence of normal pre-PCI TIMI myocardial perfusion was increased among patients treated in the ED versus CCL(24%vs 14%, P=.026). There was no excess of TIMI major or minor bleeding among patients treated in the ED versus CCL(6.9%[12/174] vs 7.8%[11/142], P=NS). Conclusion: A strategy of early initiation of eptifibatide in the ED before primary PCI for STEMI yields superior pre-PCI TIMI frame counts, reflecting epicardial flow, and superior TIMI myocardial perfusion compared with a strategy of initiating eptifibatide in the CCL without an increase in bleeding risk.
