PCI治疗前冠脉内应用尿激酶原或替罗非班对STEMI患者心肌微循环再灌注的影响及安全性

Effects and safety of intracoronary prourokinase or tirofiban on myocardial microcirculation reperfusion in patients with STEMI before PCI

目的研究经皮冠状动脉介入治疗(PCI)治疗前冠脉内应用尿激酶原或替罗非班对ST段抬高型心肌梗死(STEMI)患者心肌微循环再灌注的影响及安全性。方法回顾性选取2020年1月至2022年1月入廊坊市人民医院接受PCI治疗的150例STEMI患者,根据不同治疗方法分为研究组(n=75)与对照组(n=75)。研究组于PCI治疗前冠脉内应用尿激酶原,对照组于PCI治疗前冠脉内应用替罗非班。比较两组患者的介入相关参数[支架直径、支架长度、支架个数、支架置入、手术路径、罪犯血管]、心肌损伤标志物[肌钙蛋白Ⅰ(cTnI)、肌酸磷酸激酶同工酶MB(CK-MB)]、心肌灌注[校正的TIMI血流计帧(CTFC)、手术后2 h ST段回落幅度≥50%]水平、出血事件(颅内出血、微出血、小出血、大出血)、不良心脑血管事件(心力衰竭、卒中、心源性死亡、非致命性心肌梗死、靶血管血运重建)发生率。结果两组患者支架直径、支架长度、支架个数、支架置入、手术路径、罪犯血管差异无统计学意义(P>0.05)。研究组手术后12 h、24 h的cTnI水平为(5.08±1.21)、(8.25±2.01)ng/mL,CK-MB水平为(6.53±1.17)、(9.42±1.59)ng/mL,均较对照组[(18.14±4.53)、(29.17±8.68)ng/mL和(22.48±5.22)、(36.93±9.41)ng/mL]更低,差异均有统计学意义(P<0.05)。研究组手术后CTFC为(27.08±0.77)帧,较对照组[(30.02±1.01)帧]更低,手术后2 h ST段回落幅度≥50%患者比率为89.33%,较对照组(73.33%)更高,差异均有统计学意义(P<0.05)。两组患者手术后出血事件、不良心脑血管事件发生率差异无统计学意义(P>0.05)。结论STEMI患者PCI治疗前冠脉内应用尿激酶原相较于替罗非班的疗效更优,可进一步减轻患者心肌损伤与改善心肌微循环再灌注,且手术后出血及不良心脑血管事件发生率较低,安全性高。

Objective To investigate the effect and safety of intracoronary prourokinase or tirofiban on myocardial microcirculation reperfusion in patients with ST-segment elevation myocardial infarction(STEMI)before percutaneous coronary intervention(PCI).Methods A total of 150 STEMI patients admitted to Langfang People’s Hospital for PCI from January 2020 to January 2022 were retrospectively selected and divided into a study group(n=75)and a control group(n=75)according to different treatment methods.The study group received intracoronary prourokinase before PCI,and the control group received tirofiban intracoronary before PCI.Intervention-related parameters[stent diameter,stent length,number of stents,stent placement,surgical path,culprit vessel],myocardial injury markers[troponin I(cTnI),creatine phosphokinase isoenzymes]were compared between the two groups of patients MB(CK-MB)],myocardial perfusion[corrected TIMI flowmeter frame(CTFC),ST-segment fall≥50%at 2 h postoperatively]levels,bleeding events(intracranial hemorrhage,microbleeding,minor bleeding,major bleeding),the incidence of adverse cardiovascular and cerebrovascular events(heart failure,stroke,cardiac death,non-fatal myocardial infarction,target vessel revascularization).Results There were no significant differences in stent diameter,stent length,stent number,stent placement,surgical path,and culprit vessel between the two groups(P>0.05).The levels of cTnI in the study group were(5.08±1.21),(8.25±2.01)ng/mL,and the levels of CK-MB(6.53±1.17),(9.42±1.59)ng/mL at 12 and 24 hours after operation,which were lower than those in the control group[(18.14±4.53),(29.17±8.68)ng/mL and(22.48±5.22),(36.93±9.41)ng/mL],and the differences were significant(P<0.05).The postoperative CTFC of the study group was(27.08±0.77)frames,which was lower than that of the control group[(30.02±1.01)frames],the rate of patients with ST segment fall≥50%2 hours after surgery was 89.33%,which was higher than that of the control group(73.33%),and the differences were significant(P<0.05).There were no significant differences in the incidence of postoperative bleeding events and adverse cardiovascular and cerebrovascular events between the two groups(P>0.05).Conclusion Compared with tirofiban,intracoronary prourokinase is more effective than tirofiban in patients with STEMI before PCI.low and high security.