替罗非班在急诊经皮冠状动脉介入治疗中的应用

急诊经皮冠状动脉介入治疗（PCI）已经成为急性ST段抬高心肌梗死（STEMI）再灌注治疗的重要方法。多项大型临床试验的观察发现,一些急性心肌梗死（AMI）病人虽然经溶栓和PCI后,心外膜冠状动脉再通,但生存率并没有显著提高。     

急诊经皮冠状动脉介入治疗急性心肌梗死的近期临床观察

目的：探讨急性ST段抬高心肌梗死患者急诊经皮冠状动脉介入治疗后的近期临床观察。方法：分析2009年7月～2010年4月在我院急诊收治的STEMI并行急诊PCI患者共26例的临床资料。结果：26例STEMI患者中,从外院转入我院患者4例,转诊时间60～120 min。造影示单支病变10例（38.5%）,双支病变7例（26.9%）,三支病变9例（34.6%）,合并左主干病变2例（7.7%）。IRA为前降支15例（57.7%）,回旋支2例（7.7%）,右冠状动脉8例（30.8%）,左主干合并前降支l例（5.32%）;其狭窄程度IRA100%完全闭塞14例（53.9%）,其中1例为支架内完全闭塞。95～99%次全闭塞7例（26.9%）,70%～94%严重狭窄5例（19.2%）。24例（92.3%）成功置入支架,共计27枚,2例（7.7%）病变处血栓较硬,钢丝未能通过病变处。自患者到我院就诊至首次球囊扩张时间为20～180 min,平均60 min,术中并发症：发生无再流1例,慢血流2例,静脉多次用硝酸甘油、GPⅡb/Ⅲa受体阻滞剂替罗非班后血流恢复。1例患者支架置入后出现小分支急性闭塞,经积极处理后成功开通。术后住院期间未发生靶血管再次血运重建、梗死后心绞痛、严重心功能不全等心血管事件及出血并发症,术后1周超声心动图测定LVEF≥50%者23例（88.5%）,其中1例患者超声心动图显示左室附壁血栓,加强抗凝治疗后,随访3个月附壁血栓消失。平均住院天数为13.5 d。结论：对急性STEMI患者,最佳治疗策略是行急诊介入治疗,尽早、充分和持续开通梗死相关动脉,应当强调缩短发病至再灌注时间,体现出增强公众的健康意识和完善急救医疗服务系统至关重要。     

盐酸替罗非班在急性心肌梗死急诊介入治疗中的应用探讨

目的 观察盐酸替罗非班在急性心肌梗死急诊介入治疗患者中的应用,并探讨其护理要点.方法 2009年1月-2010年12月,我科收治的急性心肌梗死行急诊介入治疗患者48例,术中按10μg/kg 3～5min静脉推注后,改为0.1～0.15μg/(kg·min)静脉输入,持续24～72h.结果 48例患者中除3例出现牙龈出血,1例发生鼻衄,1例拔出鞘管后,腹股沟处出现严重血肿,经及时处理均好转外,其余43例均效果良好.结论 急性心肌梗死行急诊介入治疗患者应用替罗非班效果良好,但存在出血风险,应密切观察,及时处理,调整抗血小板和抗凝药物剂量,预防严重出血并发症发生.     

比伐卢定在急诊经皮冠状动脉介入中的应用观察

目的:比较比伐卢定与血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂替罗非班加肝素在急诊经皮冠状动脉介入治疗(PCI)中的疗效及安全性。方法:55例接受急诊PCI治疗的急性ST段抬高型心肌梗死患者(STEMI),随机分为比伐卢定组(23例)和替罗非班加肝素组(32例)。所有患者在发病12 h内行急诊PCI术,比伐卢定组:在急诊PCI术前静脉给予比伐卢定负荷量0.75 mg/kg,术中以1.75 mg/(kg·h)持续静脉点滴,术后以0.2 mg/(kg·h)持续静脉点滴4~20 h。替罗非班加肝素组:术前静脉内注入10μg/kg替罗非班,然后以0.075μg/(kg·h)持续静脉滴注24~36 h,同时静脉内注入普通肝素100 U/kg。观察两组PCI术后心肌梗死溶栓治疗临床试验(TIMI)血流分级,2 h心电图ST段回落百分比,两组出血的发生率。结果:比伐卢定组与替罗非班加肝素组ST段回落百分比(91.3%和93.7%),TIMI 3级血流比例(95.9%和96.8%),差异均无统计学意义(P>0.05);比伐卢定组出血发生率明显低于替罗非班加肝素组(0%和18.75%),但差异无统计学意义(P>0.05)。结论:急性ST段抬高型心肌梗死患者直接PCI时,比伐卢定与替罗非班加肝素相比有相同的疗效,临床出血率低,但统计学差异不明显,可能与样本量少有关。     

预见性护理在急性心肌梗死行急诊经皮冠状动脉介入治疗术后患者中的应用

目的 探讨预见性护理在急性心肌梗死(AMI)行急诊经皮冠状动脉介入治疗术(PCI)后患者中的应用效果.方法 对25例AMI行急诊PCI后的患者运用预见性的护理程序,对 PCI后并发症进行预见性护理.结果 本组无1例发生心包填塞,造影剂肾病支架血栓,所有患者经积极对症治疗及预见性护理均康复出院.结论 对急性心肌梗死(AMI)行急诊经皮冠状动脉介入治疗术(PCI)后患者实施预见性护理,可减少或避免心血管事件的发生和缩短有效抢救时间,提高患者生存质量和满意度.     

欣维宁在急诊经皮冠脉介入治疗的安全性研究

目的评价GPⅡb/Ⅲa受体拮抗剂盐酸替罗非班在ST段抬高急性心肌梗死（STEMI）急诊经皮冠状动脉腔内介入术（PCI）治疗中的安全性。方法 120例急诊入院STEMI行急诊PCI的患者,随机分为试验组（盐酸替罗非班＋PCI）60例和对照组（直接PCI）60例。观察2组住院期间主要心血管事件（MACE）包括死亡、新近心肌梗死和顽固缺血状态、术后左心室射血分数（LVEF）、压迫止血时间及不良反应（出血、血小板减少）。结果住院期间MACE发生率,试验组略高于对照组（10%vs 6.7%,P〉0.05）;术后LVEF（56.97±8.41vs 54.15±7.11）高于对照组;2组均未发生严重出血并发症（包括大量出血和颅内出血等）,出血事件发生率试验组较对照组有增多的趋势（8.3%比3.3%）,试验组部分凝血活酶时间（APTT）较对照组延长（53.97±10.58 vs 32.51±6.31,P〈0.05）;压迫止血时间明显延长（38.16±5.37 vs 21.34±4.96,P〈0.05）,但未增加穿刺点出血和血肿。结论盐酸替罗非班联合PCI可能成为STEMI患者急诊PCI安全和有效的再灌注手段。     

盐酸替罗非班在急性心肌梗死急诊经皮冠状动脉介入治疗中的临床研究

目的:探讨血小板糖蛋白(glycoprotein,GP)Ⅱb/Ⅲa受体拮抗剂盐酸替罗非班在急性心肌梗死(AMI)患者急诊冠状动脉介入(PCI)治疗中的疗效和安全性.方法:选择急诊人院AMI患者82例,分为替罗非班组(盐酸替罗非班 PCI)42例和对照组(直接PCI)40例,收集所有病例的临床和冠状动脉(冠脉)造影资料,观察PCI术后冠脉的血流和心血管事件发生情况.结果:替罗非班组于术前应用盐酸替罗非班使PCI前梗死相关血管心肌梗死溶栓治疗(tharombolysis in myocardial infarction,TIMI)血流分级提高,替罗非班组达1级、2级血流者比例分别高于对照组(均P<0.01),对照组完全闭塞比率明显高于替罗非班组(P<0.01);替罗非班组急诊PCI术后无慢流,无复流现象发生,TIMl3级血流发生率lOO%,对照组急诊PCI术后TI-MI 0～2级,即无复流及慢血流发生率为15%,TIMl3级血流发生率为85%,两组比较差异有统计学意义(P<0.05,P<0.01);观察住院期间盐酸替罗非班组无再梗死及死亡,对照组梗死及死亡发生率为7.5%,两组比较差异有统计学意义(P<0.05).结论:在AMI急诊PCI术前应用盐酸替罗非班既可开通冠状动脉,又可改善梗死相关冠状动脉血管的TIMI血流,减少术后再梗死,挽救心肌,可能成为更安全和有效的再灌注手段.     

术前应用替罗非班对急性心肌梗死患者急诊经皮冠状动脉介入治疗疗效的分析

目的探讨在急性ST段抬高型心肌梗死(ST segment elevation myocardial infarction,STEMI)患者行急诊经皮冠状动脉介入治疗(percuteous coronary intervention,PCI)时,术前静脉注射替罗非班对术后冠脉血流及近期疗效的影响。方法 93例急性STEMI患者行急诊PCI治疗,随机分为术前静脉注射替罗非班(早期组,46例)和造影后静脉注射替罗非班(晚期组,47例)两组。分析两组患者术前基础临床情况、术前梗死相关血管前向血流情况、术后冠脉TIMI血流分级、校正的TIMI血流计数帧数(corrected TIMI frame count,CTFC)、射线照射时间及造影剂用量、左心室射血分数、术后3个月主要心血管事件(major adversecardiac events,MACE)。结果两组患者基础临床情况差异无统计学意义,早期组患者术前梗死相关动脉(infarction related arter-y,IRA)前向血流达到TIMI2～3级的比例高于晚期组(分别为30%和13%,P=0.038)。两组患者术后IRA前向血流达到TIMI3级的比例、心功能、近期MACE比较差异无统计学意义,但早期组患者射线照射时间、CTFC及造影剂用量均少于晚期组,两组比较差异有统计学意义(P<0.05)。结论急性STEMI行急诊PCI时,替罗非班注射液的不同应用时间对近期的临床预后虽然没有明显改善,但术前静脉应用可以提高IRA前向血流TIMI3级的比例,减少射线照射及手术时间。不同应用方法均不增加出血发生率,临床应用安全有效。     

急诊经皮冠状动脉介入治疗急性心肌梗死152例临床分析

目的：分析急诊经皮冠状动脉介入治疗术（PCI）治疗急性心肌梗死（AMI）的近期疗效。方法：回顾分析我院2000～2006年152例AMI患者发病24h内急诊PCI的临床资料。结果：143例急诊PCI成功，成功率94．07％，病死率2．63％，平均住院13d。结论：对于胸痛〉12h但〈24h，仍然有缺血症状和体征的患者，急诊PCI仍然安全有效。     

替罗非班在急诊冠脉介入治疗中的应用

目的:分析替罗非班与阿司匹林、氯吡格雷、低分子肝素合用于冠脉支架术时的疗效、安全性。方法:入选2008年3月~2009年6月64例确诊急性心肌梗死并行PCI治疗的病人,随机分为两组,每组32人,对照组常规治疗,治疗组在此基础上加用替罗非班。对两组病人在疗效、不良反应等方面进行比较。结果:两组病人在出血等不良反应方面没有太大差异,在疗效方面,治疗组在给药后7 d内全因死亡、顽固性心绞痛、再发心肌梗死方面均明显少于对照组,二者差异有统计学意义。结论:对于急性心肌梗死病人行支架植入术时,在常规治疗的基础上,加用替罗非班可以明显提高疗效,而不增加不良反应。     

替罗非班对急诊经皮冠状动脉介入术患者的疗效

目的:探讨替罗非班治疗急性ST段抬高型心肌梗死(STEMI)急诊经皮冠状动脉介入术(PCI)患者的有效性及安全性。方法:对阿司匹林加氯吡格雷常规治疗组(对照组)50例和加用替罗非班三联抗血小板治疗组(观察组)50例的临床资料进行回顾分析。结果:PCI术后30 d,观察组出现的主要不良心血管事件,包括心源性死亡、非致死性心肌再梗死、靶血管再次血运重建、严重心绞痛的发生率为4.0%,低于对照组的18.0%(P0.05);PCI术后48 h及30 d,2组轻度出血及血小板减少并发症的发生率差异均无统计学意义(P0.05),2组均未发生严重出血并发症。结论:STEMI患者行急诊PCI术中及术后48 h联合应用替罗非班治疗能进一步减少术后30 d主要不良心血管事件,且安全性良好。     

Comparison of tirofiban combined with dalteparin or unfractionated heparin in primary percutaneous coronary intervention of acute ST-segment elevation myocardial infarction patients

Background  Primary percutaneous coronary intervention (PCI) is the best treatment of choice for acute ST segment elevation myocardial infarction (STEMI). This study aimed to determine the clinical outcomes of tirofiban combined with the low molecular weight heparin (LMWH), dalteparin, in primary PCI patients with acute STEMI.

Methods  From February 2006 to July 2006, a total of 120 patients with STEMI treated with primary PCI were randomised to 2 groups: unfractionated heparin (UFH) with tirofiban (group I: 60 patients, (61.2±9.5) years), and dalteparin with tirofiban (group II: 60 patients, (60.5±10.1) years). Major adverse cardiac events (MACE) during hospitalization and at 4 years after PCI were examined. Bleeding complications during hospitalization were also examined.

Results  There were no significant differences in sex, mean age, risk factors, past history, inflammatory marker, or echocardiography between the 2 groups. In terms of the target vessel and vascular complexity, there were no significant differences between the 2 groups. During the first 7 days, emergent revascularization occurred only in 1 patient (1.7%) in group I. Acute myocardial infarction (AMI) occurred in 1 (1.7%) patient in group I and in 1 (1.7%) in group II. Three (5.0%) patients in group I and 1 (1.7%) in group II died. Total in-hospital MACE during the first 7 days was 4 (6.7%) in group I and 2 (3.3%) in group II. Bleeding complications were observed in 10 patients (16.7%) in group I and in 4 patients (6.7%) in group II, however, the difference was not statistically significant. No significant intracranial bleeding was observed in either group. Four years after PCI, death occurred in 5 (8.3%) patients in group I and in 4 (6.7%) in group II. MACE occurred in 12 (20.0%) patients in group I and in 10 (16.7%) patients in group II.

Conclusions  Dalteparin was effective and safe in primary PCI of STEMI patients and combined dalteparin with tirofiban was effective and safe without significant bleeding complications compared with UFH. Although there was no statistically significant difference, LMWH decreased the bleeding complications compared with UFH.

     

Thorombolytic therapy with rescue percutaneous coronary intervention versus primary percutaneous coronary intervention in patients with acute myocardial infarction: a multicenter randomized clinical trial

Background Although thrombolytic therapy with rescue percutaneous coronary intervention （PCI） is a common treatment strategy for ST-segment elevation acute myocardial infarction （STEMI）, scant data are available on its efficacy relative to primary PCI, and comparison was therefore the aim of this study. Methods This multicenter, open-label, randomized, parallel trial was conducted in 12 hospitals on patients （age 〈70 years） with STEMI who presented within 12 hours of symptom onset （mean interval 〉3 hours）. Patients were randomized to three groups： primary PCI group （n=101）; recombinant staphylokinase （r-Sak） group （n=-104）; and recombinant tissue-type plasminogen activator （rt-PA） group （n=-106）. For all patients allocated to the thrombolytic therapy arm, coronary angiography was performed at 90 minutes after drug therapy to confirm infarct-related artery （IRA） patency; rescue PCI was performed in cases with TIMI flow grade 〈2. Bare-metal stent implantation was planned for all patients. Results After randomization it required an average of 113.4 minutes to start thrombolytic therapy （door-to-needle time）and 141.2 minutes to perform first balloon inflation in the IRA （door to balloon time）. Rates of IRA patency （TIMI flow grade 2 or 3） and TIMI flow grade 3 were significantly lower in the thrombolysis group at 90 minutes after drug therapy than in the primary PCI group at the end of the procedure （70.5% vs. 98.0%, P 〈0.0001, and 53.0% vs. 85.9%, P 〈0.0001, respectively）. Rescue PCI with stenting was performed in 117 patients （55.7%） in the thrombolytic therapy arm. Rates of patency and TIMI flow grade 3 were still significantly lower in the rescue PCI than in the primary PCI group （88.9% vs. 97.9%, P=-0.0222, and 68.4% vs. 85.0%, P=0.0190, respectively）. At 30 days post-therapy, mortality rate was significantly higher in the thrombolysis combined with rescue PCI group than in primary PCI group （7.1% vs. 0, P=0.0034）. Rates of death/MI and bleeding complications were significantly higher in the thrombolysis with rescue PCI group than in the primary PCI group （10.0% vs. 1.0%, P=-0.0380, and 28.10% vs. 8.91%, P=-0.O001, respectively）. Conclusions Thrombolytic therapy with rescue PCI was associated with significantly lower rates of coronary patency and TIMI flow grade 3, but with significantly higher rates of mortality, death/MI and hemorrhagic complications at 30 days, as compared with primary PCI in this group of Chinese STEMI patients with late presentation and delayed treatments.     

Direct intracoronary delivery of tirofiban during primary percutaneous coronary intervention for ST-elevation myocardial infarction

ST-segment elevation myocardial infarction (STEMI)is usually caused by acute occlusion of an infarct-related coronary artery (IRA),resulting from rupture or erosion of an atherosclerotic plaque and subsequent platelet aggregation and thrombosis.1-3Prompt reperfusion is the key aspect of the optimal management,4-7 and timely expert primary percutaneous coronary intervention (PCI) becomes the best reperfusion strategy with respect to improvement in survival and reduction of combined clinical endpoints in the treatment of STEMI.8-11 Given the high thrombotic risk of patients with STEMI,pretreatment with a high clopidogrel loading dose before primary PCI was advised to reduce distal thrombotic embolization and angiographic no-reflow and improve clinical outcomes.12,13 The use of adjunctive intravenous glycoprotein (GP) Ⅱb/Ⅲa inhibitors following oral dual-antiplatelet therapy enhances thrombus disaggregation by inhibiting fibrinogen binding to the active receptor complex and subsequently disrupting platelet cross-linking,14 and improves IRA patency and myocardial perfusion,14 and has been recommended as class Ⅱa (at the time of primary PCI) or Ⅱb (before primary angiography and PCI)indication in the recent practice guidelines for the management of patients with STEMI.9,10 Tirofiban (a small-molecule platelet GP Ⅱb/Ⅲa inhibitor) seems even more attractive,because of its consistent and rapidly reversible platelet inhibition at increased dose and efficient penetration into the platelet-fibrin thrombus.15 In a broad population of largely unselected patients undergoing primary PCI for STEMI,tirofiban was associated with a noninferior complete resolution of ST-segment elevation (an indirect measure of myocardial reperfusion after PCI14,16) compared with abciximab,17 and was well tolerated and effective in reducing ischemic acute coronary syndrome complications in patients with mild-to-moderate renal insufficiency.18 Previous studies have shown that an upstream low dose of tirofiban favorably ameliorates IRA patency and reperfusion of the infarct area compared with down-stream use,19 and routine initiation of high-bolus dose of tirofiban could further improve clinical outcome after primary PCI.20 These observations highlight that further platelet aggregation inhibition besides high-dose clopidogrel is mandated in patients with STEMI undergoing primary PCI.     

糖尿病合并急性心肌梗死急诊介入治疗疗效

目的 评价糖尿病患者合并急性心肌梗死急诊介入治疗的疗效。方法 分析1997.2-1999.12中88例伴糖尿病与216例不伴糖尿病急性心肌梗死行急诊介入治疗患者的临床疗效。结果 糖尿病组伴心源性休克15例,死亡率为4.5％,成功率94.0％。78例成功介入治疗患者随访(11.7±7.8)月,主要不良心脏事件(MACE)发生率28.2％。不伴糖尿病组中有29例合并心源性休克,死亡率为1.9％,成功率97.1％,其中178例随访(12.6±8.3)月期间MACE发生率为18.0％。急诊介入治疗成功率两组相似,近期死亡率和中远期MACE发生率糖尿病组也无明显增高(P>0.05),女性患者的比例在糖尿病组明显增高(P=0.01)。结论 急诊介入治疗糖尿病合并急性心肌梗死安全可靠,效果佳。     

Randomized comparison of intracoronary tirofiban versus urokinase as an adjunct to primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction: results of the ICTUS-AMI trial

Background No randomized trial has been performed to compare the efficacy of an intracoronary bolus of tirofiban versus urokinase during primary percutaneous coronary intervention （PCI）.We investigated whether the effects of adjunctive therapy with an intracoronary bolus of urokinase was noninferior to the effects of an intracoronary bolus of tirofiban in patients with ST-elevation myocardial infarction （STEMI） undergoing PCI.Methods A total of 490 patients with acute STEMI undergoing primary PCI were randomized to an intracoronary bolus of tirofiban （10 μg/kg; n=247） or urokinase （250 kU/20 ml; n=243）.Serum levels of P-selectin,von Willebrand factor （vWF）,CD40 ligand （CD40L）,and serum amyloid A （SAA） in the coronary sinus were measured before and after intracoronary drug administration.The primary endpoint was the rate of complete （＞70％） ST-segment resolution （STR） at 90 minutes after intervention,and the noninferiority margin was set to 15％.Results In the intention-to-treat analysis,complete STR was achieved in 54.4％ of patients treated with an intracoronary bolus of urokinase and in 60.6％ of those treated with an intracoronary bolus of tirofiban （adjusted difference：-7.0％;95％ confidence interval：-15.7％ to 1.8％）.The corrected TIMI frame count of the infarct-related artery was lower,left ventricular ejection fraction was higher,and the 6-month major adverse cardiac event-free survival tended to be better in the intracoronary tirofiban group.An intracoronary bolus of tirofiban resulted in lower levels of P-selectin,vWF,CD40L,and SAA in the coronary sinus compared with an intracoronary bolus of urokinase after primary PCI （P＜0.05）.Conclusions An intracoronary bolus of urokinase as an adjunct to primary PCI for acute STEMI is not equally effective to an intracoronary bolus of tirofiban with respect to improvement in myocardial reperfusion assessed by STR.This may be caused by less reduction in coronary circulatory platelet activation and inflammation.     

急诊PCI替罗非班预防无复流的作用

目的探讨急诊经皮冠状动脉介入治疗(PCI)替罗非班预防冠脉无复流的作用。方法回顾分析急诊PCI患者90例,根据PCI术前及术中是否使用替罗非班,分为替罗非班组50例(无复流3例,血流正常47例),对照组40例(无复流12例,血流正常28例),记录两组基础临床情况、观察两组患者术中无复流发生率。结果替罗非班组无复流发生率6%明显低于对照组30%,两组间差异有统计学意义(P<0.05)。结论急诊PCI加强抗血小板治疗能减少无复流的发生,提高手术的近期疗效。     

直接冠脉介入治疗急性心肌梗死临床分析

目的 探讨急性心肌梗死直接经皮冠脉介入治疗(PCI)的疗效,方法及安全性.方法 建立急性心肌梗死"绿色通道",对236例急性心肌梗死患者,采用经股动脉或经桡动脉途径常规方法,行直接PCI,观察梗塞相关动脉的开通率、血流情况、术中并发症,住院期间主要心血管事件,随访观察预后、再狭窄及再次血运重建情况.结果 呼叫到球囊开通时间为(88±36)min,227例患者成功开通梗死相关动脉.TIMI血流3级(96.2%),9例发生无再流,共植入支架235个.无严重手术并发症发生,15例心原性休克患者11例存活(73.3%),5例心肺复苏患者3例生存.住院期间死亡10例,死亡原因为心力衰竭、休克和室颤.随访期间再发心肌梗死7例,死亡4例.87例复查冠脉造影,19例再狭窄,12例再次行PCI术,3例行冠脉搭桥术.结论 直接PCI治疗急性心肌梗死安全有效,在有条件的医院可首选PCI作为急性心肌梗死治疗的方法.     

重组人B型脑利钠肽对急性心肌梗死患者急诊经皮冠状动脉介入治疗后对比剂肾病的预防作用

目的:探讨急性心肌梗死患者接受急诊经皮冠状动脉介入治疗（PCI）后,新活素（冻干重组人脑利钠肽）对于对比剂肾病（CIN）的预防及肾功能的保护作用。方法:将88例急性心肌梗死接受急诊PCI治疗的患者随机分为试验组（45例）和对照组（43例）,急诊PCI术后试验组即刻开始应用冻干重组人脑利钠肽0.007 5～0.015 μg/（kg·min）,持续48～72 h,试验组及对照组术后均接受0.9%氯化钠生理盐水1 mL/（kg·min）持续水化治疗维持至术后12～24 h,分别于术前及术后48、72 h测定血清肌酐（SCr）、血清胱抑素C（Cys C）。结果:试验组PCI术后72 h较基线的SCr及估算的肾小球滤过率（eGFR）差值显著低于对照组（Scr升高值:5.33 vs.17.93, P=0.020;eGFR降低值:4.24 vs.12.18, P=0.008）,同时试验组CIN发生率较对照组明显降低（P=0.042）,Logistic回归分析显示应用冻干重组人脑利钠肽为CIN的保护因素（OR=0.04,95%CI:0.00～0.36）。结论:对于急性心肌梗死行急诊PCI治疗后应用冻干重组人脑利钠肽可保护肾功能,减少对比剂肾病发生率。     

Improved outcomes from transradial over transfemoral access in primary percutaneous coronary intervention for patients with acute ST-segment elevation myocardial infarction and upstream use of tirofiban

Background Transradial access has been increasingly used during primary percutaneous coronary intervention (PCI)for patients with acute ST-segment elevation myocardial infarction (STEMI) in last decade...