冠状动脉内注射替罗非班对急性冠脉综合征介入治疗中无复流的影响

目的评价冠状动脉内应用替罗非班对急性冠脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)中无复流的临床疗效。方法在行PCI治疗中发生无复流的ACS患者分别经冠状动脉内注入替罗非班(替罗非班组,n=21)和维拉帕米(维拉帕米组,n=24),两组手术方法相同。观察两组注射药物后首次和PCI中末次造影图像,评估TIMI血流分级、校正的TIMI帧数(cT-FC),同时测定PCI术后7 d、14 d的左室射血分数(LVEF)、肌酸激酶同工酶(CK-MB)血小板计数(PLT),两组术后3 d内出血及术后30 d内主要心血管事件(MACE),并进行统计学比较。结果冠状动脉内注射药物后首次及PCI结束前末次冠脉造影均显示:替罗非班组TIMI3级血流比例明显高于对照组;替罗非班组cTFC帧数明显少于对照组;PCI术后7 d、14 d的LVEF均高于对照组,CK-MB均低于对照组,差异均有统计学意义(P0.05);PLT两组间差异无统计学意义。两组术后3 d内出血、术后30 d内MACE比较无统计学意义(P0.05)。结论冠状动脉内注射替罗非班可以增加ACS患者PCI术中发生无复流后冠状动脉血流和心肌组织灌注,降低术后炎症反应程度。

Effects of intracoronary injections of tirofiban in acute coronary syndrome patients with no reflow phenomenon after percutaneous coronary intervention

Objective To investigate the effect of intracoronary tirofiban administration on no reflow phenomenon during primary percutaneous coronary intervention(PCI) in patients with acute coronary syndrome(ACS).Methods A total of 45 patients with ACS undergoing PCI were randomly divided into tirofiban group(n=21) and verapamil group(n=24).The two groups were administered intracoronary bolus tirofiban or verapamil during PCI respectively.All patients underwent one standard of PCI.Thrombolyses in myocardial infarction(TIMI)grade were observed immediately by angiography after the administration and before the end of PCI.Baseline characteristics,TIMI grade and corrected TIMI frame count(cTFC)of the two groups were compared.Meanwhile,left ventricular ejection fraction(LVEF),the plasma creatine kinase-MB(CK-MB)and platelet count(PLT)after 7days and 14days of PCI,and incidence of major adverse cardiac event(MACE) after 30 days were also recorded and done statistical analysis.Results Compared with verapamil group,Tirofiban treated group showed significantly higher TIMI3 flow degree in the first contrastographic picture after administeration and in the last contrastographic picture of after PCI(P<0.05).cTFC was significantly decresased in tirofiban treated group in the first contrastographic picture after administration and in the last contrastographic picture post PCI as compared to control group(P<0.05).The LVEFs after 7 days and 14 days PCI were higher than those in the verapamil group(P<0.05),the plasma CK-MB after 7days and 14days PCI were lower than those in the verapamil group(P<0.05).and there was no statistical differences in PLT,bleeding complications and MACE between two groups(P>0.05).Conclusion Intracoronary injections of tirofiban to ACS patients with no reflow phenomenon during PCI could improve coronary arterial blood flow and myocardial tissue perfusion.