替罗非班联合血栓抽吸在急诊PCI治疗STIMI中的效果及预后分析

Effect and prognosis of tirofiban combined with thrombus aspiration in emergency PCI forpatients with STIMI

目的比较行急诊经皮冠状动脉介入治疗(PCI)的ST段抬高型心肌梗死(STIMI)患者选择替罗非班联合血栓抽吸与单独使用替罗非班的临床疗效及预后情况。方法收集阜阳市人民医院2018年1月至2021年4月期间于急诊科就诊后至心血管内科急诊行PCI治疗的171例STIMI患者。按照术中治疗方式的不同分为研究组(74例)和对照组(97例)。研究组在PCI治疗中使用血栓抽吸导管联合冠状动脉内注射替罗非班,对照组则单独使用冠状动脉内注射替罗非班+PCI。比较两组患者术后梗死血管心肌梗死溶栓试验(TIMI)血流分级、术后1周内射血分数、心血管不良事件发生率、卒中发生率、出血发生率、住院天数、花费及术后1年内再次住院率。组间比较采用t检验、秩和检验、χ^(2)检验或Fisher精确检验。结果两组患者住院期间术后梗死血管TIMI血流分级、射血分数、心血管不良事件、脑卒中发生率、出血发生率、术后1年内因心血管疾病再住院率比较,差异均无统计学意义(均P>0.05)。研究组首次住院天数为10.5(9.0,13.0)d,住院花费为31951.3(26137.7,38866.0)元,对照组分别为9.0(8.0,11.5)d、28 668.6(25 773.6,32 972.3)元,差异均有统计学意义(Z=-2.459、-2.207,P=0.014、0.027)。结论在冠状动脉内注射替罗非班基础上使用血栓抽吸治疗,相较于单独使用替罗非班对STIMI患者行急诊PCI术后未见临床疗效进一步改善及预后相关不良事件发生率减低,反之还有延长住院时长、提高住院费用可能,不应推荐常规使用。

Objective To compare the clinical efficacies and prognosis of tirofiban combined with thrombus aspiration and tirofiban alone for patients with ST segment elevation myocardial infarction(STIMI)undergoing emergency percutaneous coronary intervention(PCI).Methods One hundred and seventy-one patients with STIMI who went to Department of Cardiovascular Medicine,Fuyang People's Hospital from the Emergency Department for emergency PCI from January 2018 to April 2021 were collected.The patients were divided into a study group(74 cases)and a control group(97 cases)according to the intraoperative treatment methods.The study group used thrombus aspiration catheter and intracoronary injection of tirofiban in PCI.The control group were treated by intracoronary injection of tirofiban and PCI.The thrombolysis in myocardial infarction(TIMI)blood flow grades of infarcted artery after operation,ejection fractions within one week after operation,incidences of cardiovascular adverse events,incidences of stroke,incidences of bleeding,lengths of hospital stay,cost,and re-hospitalization rates within one year after operation were compared between these two groups.The data were compared between these two groups by t test,χ^(2) test,or Fisher's precision probability test.Results There were no statistical differences in TIMI blood flow grade,ejection fraction,incidence adverse cardiovascular events(MACE),incidence of stroke,incidence of bleeding,and readmission rate due to cardiovascular disease within one year after operation between the two groups during hospitalization(all P>0.05).The first hospitalization days and cost were 10.5(9.0,13.0)d and 31951.3(26137.7,38866.0)in the study group,and were 9.0(8.0,11.5)d and 28668.6(25773.6,32972.3)in the control group,with statistical differences(Z=-2.459 and-2.207,P=0.014 and 0.027).Conclusions The combination of tirofiban and thrombus aspiration therapy on the basis of intracoronary injection does not improve the clinical efficacy and reduce the incidence of adverse events related to prognosis in patients with STIMI after emergency PCI as compared with tirofiban alone.On the contrary,it is possible to prolong the length of hospitalization and increase the cost of hospitalization,so conventional use should not be recommended.