大剂量替罗非班对急性ST段抬高型心肌梗死患者急诊介入治疗短期疗效及安全性研究

目的探讨急性ST段抬高型心肌梗死(STEMI)患者行急诊经皮冠状动脉介入治疗(PCI)时,早期应用大剂量替罗非班对介入治疗疗效的影响。方法入选116例STEMI急诊介入治疗的患者,所有患者均于冠状动脉造影前给予阿司匹林300 mg、氯吡格雷600 mg,按随机数字法分为大剂量替罗非班组(A组25μg/kg,负荷剂量静脉推注)39例,常规剂量组(B组10μg/kg,负荷剂量静脉推注)39例,替罗非班负荷剂量均于3 min内静脉推注,继之0.15μg·kg~(-1)·min~(-1)静脉维持泵入36 h。对照组(C组)38例。PCI术后梗死相关血管的心肌梗死溶栓(TIMI)血流分级、TIMI心肌灌注分级(TMPG)、术后即刻和24 h ST段完全回落率、术后1周左右(5～7 d)的左心室射血分数(LVEF)、术后1个月的主要心血管事件(死亡、再发心肌梗死、靶血管血运重建、反复心绞痛发作)及TIMI出血事件作为评价指标。结果术前3组患者基线资料(年龄、性别构成、危险因素、心功能Killip分级、治疗时间段、住院天数等)差异无统计学意义,具有可比性。术后即刻TIMI 3级血流获得率A组(97.4%)和B组(89.7%)高于C组(76.3%),差异有统计学意义(均为P<0.05),但A、B组相比差异无统计学意义(P>0.05)。PCI术后3组的TMPG 3级率相比差异有统计学意义(A组:82.1%,B组:69.2%,C组:47.4%,P<0.01)。术后24 h ST段完全回落率及1周左右的LVEF,A组显著高于C组(64.1%比42.2%,61%±9%比55%±9%,P<0.05)。术后1个月随访,3组在主要心血管事件的发生率上差异无统计学意义(P>0.05),仅A组术后1个月反复心绞痛的发作率明显低于C组(2.6%比13.2%,P=0.04)。3组在主要出血事件的发生率上差异无统计学意义(均为P>0.05)。结论对于急性STEMI患者,早期应用大剂量替罗非班可以获得更好的即刻造影结果,且并未明显增加主要出血事件的发生率,可提高临床预后。

Efficacy and safety of high-loading-dose Tirofiban in patients with acute ST-elevation myocardial infarction underwent primary percutaneous coronary intervention

Objective To investigate the efficacy and safety of early application of high-loading-dose tirofiban in patients with acute ST-segment elevation myocardial infarction （STEMI） underwent primary pereutaneous coronary intervention （PCI）. Methods A total of 120 patients with acute STEMI were recruited and randomly divided into three groups： conventional tirofiban group （10 p.g/kg bolus then 0. 15 μg. kg-1 miu- 1 infusion for 36 h）, high-dose tirofiban group （25 μg/kg bolus then 0. 15 μg.kg-1 .min-1 infusion for 36 h） and control group （without tirofiban）. All patients were given elopidogrel 600 mg loading dose before primary PCI. The thrombolysis in myocardial infarction （ TIMI ） flow grade, TIMI myocardial perfusion grading （TMPG）, ST-segment complete recovery rate within 24 h, left ventricular ejection fraction （LVEF）, major adverse cardiac events （MACEs, including death, re-infarction, target vessel revascularization, recurrent angina pectoris） and TIMI bleeding events were recorded. Results Baseline data （including age, sex, risk factors and duration of hospitalization） of three groups were comparable. Immediate TIMI flow grade and TMPG after PCI in high-dose tirofiban group were significantly higher than in conventional tirofiban group （ all P 〈 0. 05 ）.ST-segment complete recovery rate within 24 h and LVEF at one week in high-dose tirofiban group were significantly higher than in control group （ all P 〈 0. 05 ）. MACE rate among the three groups at one month were similar. The rate of recurrent angina in high-dose tirofiban group was significantly lower than in control group （2. 6% vs. 13.1% , P = 0. 04）. The incidence of major bleeding among the three groups was similar. Conclusions Early use of high-dose tirofiban before primary PCI in patients with acute STEMI is safe and can achieve better clinical outcome.