替罗非班联合雷帕霉素洗脱支架在急诊冠状动脉介入治疗中的应用

目的评价替罗非班联合雷帕霉素洗脱支架在急诊冠状动脉介入治疗中应用的疗效及安全性。方法入院诊断为急性心肌梗死并行急诊冠状动脉介入治疗的患者126例,分为试验组60例和对照组66例。试验组于术前给予替罗非班并维持36h,植入雷帕霉素洗脱支架;对照组单纯植入金属裸支架。观察两组手术成功率,手术前后TIMI血流分级,住院期间和6个月主要不良心脏事件（MACE）以及左室射血分数（LVEF）、心功能纽约心脏病协会（NYHA）分级,出血及血小板减少并发症,并作统计学分析。结果两组手术成功率、术前TIMI血流、住院期间MACE和LVEF相似（P〉0．05）。与对照组相比较,试验组术后TIMI3级血流比例较高,6个月MACE发生率较低（其中主要是靶血管再次血运重建减少）,同时LVEF较高和NYHAI级比例较大,差异均有统计学意义（P〈0．05）。试验组出血并发症较多见（P〈0．05）,但主要为不明显出血（P〈0．05）;两组均无重度出血和血小板减少。试验组无支架血栓形成发生。结论替罗非班联合雷帕霉素洗脱支架在急诊冠状动脉介入治疗中应用能改善冠状动脉血流和心功能,降低6个月不良心血管事件,并不增加严重出血和支架内血栓形成,具有良好疗效和安全性。

Application of tirofiban combined with sirolimus drug-eluting stent on emergency percutaneous coronary intervention

Objective To evaluate the efficaey and safety of tlrofiban combined with sirolimus - eluting stent（SES） on emergency pereu- taneous coronary intervention（PCI） in patients with acute myocardial infarction（AMI）. Methods 126 AMI patients underwent emergency PCI were divided into two groups ： the trial group （ n = 60 ） and the control group （ n = 66）. The trial group were given tirofiban [ a bolus dose of 10 μg/kg and sustaining dose of 0. 15 μg/（ kg ·min） for 36 hours ] and received SESs, the control group received bare metal stents（BMSs） alone. The success rate of operation, TIMI grade of coronary blood flow before and after PCI, major adverse cardiac events （MACE） during hospitalization and 6 months follow - up, left ventricular ejection fraction（LVEF） , NYHA grade of heart function, bleeding complications and thrombocytopenia were observed and analyzed. Results The success rate of operation, TIMI flow before PCI, the rate of MACE and LVEF during hospitalization were all similar between the two groups（ P 〉0.05）. No stent thrombosis in the trial group. The rate of TIMI 3 flow after PCI was higher in the trial group （ P 〈 0.05 ）. At 6 months follow -up, the rate of MACE was significantly lower in the trial group（ P 〈 0.05 ）connected with decrease in the rate of target vessel revascularization（ P 〈 0.05 ）. LVEF was better（ P 〈 0.05 ） and the rate of NYHA I heart function was higher （ P 〈 0.05 ） in the trial group. More patients suffered blecding complications（ P 〈 0.05 ）in the trial group than in the control group. But they were insignificant hem- orrhage mainly（ P 〈 0.05 ） ： No major hemorrhage and thrombocytopenia in both groups. Conclusion tirofiban combined with SES on emergency PCI in patients with AMI was safe and effective . It may improve coronary blood flow and heart function, and may also reduce MACE at 6 month, without increase major hemorrhage and stent thrombosis.