低剂量替罗非班在老年急性ST段抬高心肌梗死急诊冠脉介入治疗中的应用

目的探讨低剂量替罗非班在老年急性ST段抬高心肌梗死(STEMI)患者(≥75岁)急诊经皮冠脉介入(PCI)治疗中应用的疗效及安全性。方法前瞻性入选2009年3月至2013年3月因STEMI行急诊PCI的老年患者172例,随机分为标准剂量组、低剂量组及对照组。标准剂量组术前给予替罗非班10μg/kg在3 min内静脉推注,然后以0.10~0.15μg/(kg·min)静脉滴注维持48 h。低剂量组术前给予负荷量(5μg/kg)在3 min内静脉推注后以0.05~0.075μg/(kg·min)静脉滴注维持24 h。对照组术前仅应用基础用药:阿司匹林300 mg和氯吡格雷300 mg顿服。比较3组患者开通梗死相关动脉(IRA)后心肌梗死溶栓(TIMI)及心肌再灌注(MBG)2~3级血流率,术后90min心电图ST段回落百分比(sum-STR);术后左室射血分数(LVEF)、左室舒张末期内径(LVEDD)和左室收缩末期内径(LVESD)的变化;术后主要心脏不良事件(死亡、再梗死、靶血管重建和脑卒中)及出血、消化道不良症状的发生率。结果标准剂量组和低剂量组的TIMI及MBG 2~3级血流率较对照组高(P0.05),标准剂量组与低剂量组间差异无统计学意义;标准剂量组和低剂量组术后90 min sumSTR50%比例较对照组高,标准剂量组与低剂量组无统计学差异;3组患者住院期间不良事件发生率无统计学差异;低剂量组的出血发生率低于标准剂量组,差异有统计学意义(6.78%比21.05%,P0.05),低剂量组和对照组的出血发生率无差异。结论在老年STEMI接受急诊PCI治疗的患者中,低剂量替罗非班在预防缺血方面的疗效与标准剂量替罗非班相当,但在出血风险方面的安全性明显升高。

Efficacy and safety of low-dose tirofiban in aged patients with ST-segment elevation acute myocardial infarction undergoing primary percutaneous coronary intervention

Objective To study the efficacy and safety of low-dose tirofiban in the treatment of elderly patients with ST- segment elevation myocardial infarction （STEMI） who underwent primary percutaneous coronary intervention. Methods From March 2009 to March 2013, a total of 172 elderly patients with STEMI treated with PCI were randomly divided into low-dose tiro- fiban （LD） group and standard-dose（SD） group and the control group.In SD group tirofiban was administered intravenously with a bolus dose of 10μg/kg within 3 minutes and followed by continuous intravenous infusion of 0. 10-0. 15μg/（kg·min） for 48 h, compared with a bolus dose of 5 μg/kg and followed by continuous intravenous infusion of 0. 05-0. 075 μg/（kg·min） for 24 h in LD group.Control group received preoperative medication with aspirin 300 mg,clopidogrel 300 mg, one time per day.The throm- bolysis in myocardial infarction （TIMI） grade flow, the myocardial blush grade（MBG） and the resolution of the sum of ST-segment elevation（sumSTR） 90 minutes after the operation were compared between the two groups. Left ventricular ejection fraction （LVEF） and left ventricular end diastolic dimension （LVEDD） and left ventricular end systolic dimension（LVESD） were measured and compared. The incidence of the major adverse cardiovascualr events（MACE） and bleeding complications and gastroin- testinal adverse symptoms were compared. Results The proportions of TIMI grade 2-3 and the myocardial blush grade 2-3 were higher in SD and LD group than that in control group, but there was no difference between SD and LD group. The resolution of the sum of ST-segment elevation（sumSTR） 90 minutes after the operation was higher in SD group and LD group than that in control group. There was no statistically significant difference in MACEs between three groups. The incidence of minor bleeding was significantly lower in LD group than that in SD group （6. 78% vs. 21.05%, P〈0. 05）, LD group and the control group was of no difference in bleeding. Condusions Low-dose tirofiban is not inferior to standard-dose in efficacy, what＇s more, low-dose tirofiban shows a better safety characteristic of lower bleeding risk.