磺达肝癸钠在急性ST段抬高心肌梗死患者冠状动脉介入治疗围术期应用的安全性和有效性评价

目的评价接受经皮冠状动脉介入治疗（PCI）的急性ST段抬高心肌梗死（STEMI）患者应用磺达肝癸钠的临床疗效、安全性及预后。方法回顾性分析2010年3月至2011年7月沈阳军区总医院STEMI患者1184例,其中接受PCI的患者为1098例（磺达肝癸钠组527例及依诺肝素组571例）,观察接受PCI的患者住院期间出血情况、院内再发心肌梗死发生率、冠状动脉病变特点及住院和随访期间（1个月）死亡率。结果接受PCI的磺达肝癸钠组与依诺肝素组比较：两组院内再发心肌梗死发生率2.3%（12/527）比2.6%（15/571）,P=0.708]、出院30 d死亡率4.0%（21/527）比4.9%（28/571）,P=0.387]差异无统计学意义,但磺达肝癸钠组院内大出血发生率显著降低1.7%（9/527）比3.7%（21/571）,P=0.045]且差异具有统计学意义。磺达肝癸钠组中替罗非班组（PCI术中应用替罗非班）的血流TIMI分级Ⅲ级获得率显著高于标准治疗组（PCI术中未应用替罗非班）94.5%（206/218）比79.0%（244/309）,P〈0.001],但出血发生率两组间差异无统计学意义1.83%（4/218）比1.62%（5/309）,P=0.850]。两组住院及随访期间主要心血管事件发生率差异均无统计学意义（P均〉0.05）。结论磺达肝癸钠对STEMI患者行PCI是安全的,联合替罗非班可以显著改善PCI术后的冠状动脉血流及临床预后,并且降低院内大出血风险。

Efficacy and safety of fondaparinux during percutaneous coronary intervention therapy in acute ST-elevation myocardial infarction patients

Objective To evaluate efficacy and safety of Fondaparinux in patients with acute STelevation myocardial infarction（ STEMI） undergoing percutaneous coronary intervention（ PCI）. Methods From March 2010 to July 2011,1184 patients with acute ST-elevation myocardial infarction were enrolle.Among patients receiving PCI treatment（ n = 1098）,the fondaparinux group included 527 cases and the enoxaparin group included 571 cases. Outcomes study included major bleeding,mortality of the in-hospital reinfarction,angiographic characteristics, all-cause mortality during hospitalization and 30 days after discharge. Results The mortality of the in-hospital reinfarction 2. 3%（ 12 /527） vs. 2. 6%（ 15 /571）,P= 0. 708] and the mortality of 30 days follow-up 4. 0%（ 21 /527） vs. 4. 9%（ 28 /571）,P = 0. 387 ],were not significantly different between the two groups. Compared with the enoxaparin group,the incidence of major bleeding of the fondaparinux group was significantly lower 1. 7%（ 9 /527） vs. 3. 7%（ 21 /571）,P= 0. 045]. The rate of complete revascularization for the patients with tirofiban during PCI 94. 6%（ 206 /218） vs. 79. 0%（ 244 /309） ] was significantly higher than the patients without tirofiban（ the standard therapy group） during PCI（ P 〈 0. 05）. However the rate of bleeding was not significantly higher than the standard therapy group 1. 83%（ 4 /218） vs. 1. 62%（ 5 /309）, P = 0. 850]. The rates of major cardiovascular events occurred during hospitalization and 30 days after discharge between the two groups showed no significant difference（ P 〉 0. 05）. Conclusions Fondaparinux,which can significantly improve coronary blood flow and clinical outcome after PCI combined tirofiban,with decrease risk of big bleeding,is feasible and safe for the patients with STEMI during PCI therapy.