早期应用替罗非班对急诊冠脉介入术后心肌微循环再灌注的影响

目的:探讨早期应用替罗非班对直接经皮冠脉介入术(PCI)术后心肌微循环再灌注的影响。方法:初发ST段抬高急性心肌梗死(STEMI)拟行直接PCI术病人131例,A组(n=32,阿司匹林、氯吡格雷和替罗非班),B组(n=99,阿司匹林和氯吡格雷)。全部病人即刻嚼服阿司匹林300 mg,后100 mg·d~(-1);口服氯吡格雷300 mg,后75 nag·d~(-1)。A组再给予替罗非班注射液10μg·kg~(-1)负荷剂量,推注3 min,而后0．15μg·kg~(-1)·min~(-1)持续静脉滴注48 h。入选后即刻测定血小板聚集率、活化状态及心电图,24 h和72 h复查。结果:入选24 h后,A组血小板聚集率及活化状态较B组明显下降(P＜0．05),ST段完全回落率明显高于B组(P＜0．05)。与B组相比,A组梗死相关动脉(IRA)狭窄程度较轻(69±s 11)％vs (87±8)％,P=0．03]。PCI术后心肌梗死溶栓试验(TIMI),血流3级A组高于B组(97％vs 82％, P=0．045),TIMI血流灌注分级(TMPG),3级A组高于B组(63％vs 42％,P=0．048)。治疗期间轻度血小板减少和出血A组高于B组(9％vs 1％,P=0．045)。随访30 d,2组死亡率无差异,但主要不良心脏事件(MACE)发生率A组低于B组(6％vs 27％,P=0．013),进一步分析A组严重心绞痛(6％vs 21％,P＜0．05)及靶血管再次血运重建术(6％vs 25％,P=0．021)较B组显著降低。结论:在阿司匹林和氯吡格雷基础上早期应用替罗非班,可进一步抑制血小板功能,减少STEMI再灌注后无再流或慢血流的发生,改善心肌微循环再灌注及病人预后。

Effects of tirofiban on improving myocardium reperfusion in patients with acute ST segment elevation myocardial infarction after emergency percutaneous coronary intervention

AIM:To evaluate the effects of tirofiban on myocardium reperfusion after primary percutaneous coronary intervention(PCI).METHODS:One hundred and thirty-one patients with ST elevation acute myocar- dial infarction(≤12 h),who underwent primary PCI,were randomized into two groups.Thirty-two patients in group A were treated with tirofiban,ninety-nine patients in group B were treated routinely without tirofiban.All patients were given aspirin and clopidogrel 300 mg at the time of grouping,then aspirin 100 mg·d~(-1)and clopidogrel 75 mg·d~(-1).Tirofiban was administered immediately after enrollment with a loading dose of 10μg·kg~(-1)for 3 min, followed by infusion of 0.15μg·kg~(-1)·min~(-1)for 48 h.Platelet aggregation and activation function,blood routines, blood coagulation routines and ECG were measured at 0,24,72 h.RESULTS:Compared with group B,resid- ual stenosis of IRA((69±s 11 )% vs(87±8)%,P＜0.05)was light and TIMI grade 3 flow rate after PCI was high in group A(97% vs 82%,P＜0.05).Normal TIMI myocardial perfusion grade(TMPG)3 was 63% in group A and 42% in group B after PCI(P＜0.05).During the follow-up of 30 days,there was no significant difference in cardiac death rate between two groups(0% vs 3%,P＞0.05),but the major adverse cardiac events(including cardiac death,non-fatal myocardial reinfarction,target vessel revascularization and severe angina)were significantly less frequent in group A(6% vs 27%,P＜0.05).Less patients in group A suffered from severe angina(6% vs 21%,P＜0.05)and target vessel revascularization(6% vs 25%,P＜0.05). Platelet aggregation and activation function decreased significantly in group A at 24 h from the onset of tirofiban infusion.The rate of complete ST segment resolution was significantly higher in group A than that in group B at 24 h and 7 d after primary PCI(P＜0.05).CONCLUSION:Early application of tirofiban before primary PCI could improve myocardial tissue-level reperfusion remarkably.Platelets might be vital in early reperfusion injury after primary PCI and demonstrates the benefit of GPⅡb/Ⅲa receptor inhibitors on microvascular flow.