冠脉内小剂量替罗非班联合血栓抽吸治疗急性ST段抬高型心肌梗死疗效观察

目的 评价冠脉及静脉内小剂量注射替罗非班联合冠脉内血栓抽吸对急性ST段抬高型心肌梗死（STEMI）急诊经皮冠状动脉介入（PCI）梗死相关血管血流及预后的影响.方法 选择诊断为STEMI、接受直接PCI治疗患者133例,随机分为冠脉及静脉内注射小剂量血小板膜糖蛋白Ⅱb/Ⅲa（GPⅡb/Ⅲa）受体拮抗剂替罗非班联合冠脉内血栓抽吸组（治疗组,67例）和常规PCI联合静脉内大剂量替罗非班组（对照组,66例）.评估两组PCI前后梗死相关血管TIMI血流分级、心肌灌注情况、术后90天主要心血管事件（MACE）及术后出血情况.结果 两组血管开通率均为100%,与对照组比较,治疗组无复流减少,心肌灌注情况改善、90天MACE下降（2.9% vs.12.1%,P＜0.05）.而围术期出血发生率无明显差异.结论 冠脉及静脉内小剂量注射替罗非班联合血栓抽吸可有效改善STEMI患者梗死相关血管的血流,改善患者预后,并具有较好的安全性.

Treatment of acute ST-segment elevation myocardial infarction with low-dose intra-coronary injection of tirofiban combining thrombus aspiration

Objective To review the influences of low-dose intra-coronary or intra-vein injection of tirofiban combining thrombus aspiration on the infarction-related vascular flow and prognosis in the patients with ST-segment elevation myocardial infarction (STEMI) after emergency percutaneous coronary intervention (PCI). Methods The patients (n=133) diagnosed STEMI and accepted direct PCI were selected and randomly divided into treatment group [treated with low-dose intra-coronary or intra-vein injection of tirofiban-the antagonist of platelet membrane glycoprotein IIb/IIIa (GPIIb/IIIa) combining thrombus aspiration, n=67] and control group (treated with routine PCI combining high-dose intra-vein injection of tirofiban, n=66). The blood flow grading of TIMI of infarction-related vascular before and after PCI, myocardial perfusion, major adverse cardiac events (MACE) within 90 days after PCI and bleeding complications after PCI were reviewed in two groups. Results The vascular patency rate was 100% in two groups. Compared with control group, the incidence of no reflow decreased, myocardial perfusion was relieved, and MACE within 90 days after PCI decreased in treatment group (2.9% vs. 12.1%, P<0.05). The incidence of bleeding complications in perioperative period was not different between two groups. Conclusion The therapy of low-dose intra-coronary or intra-vein injection of tirofiban combining thrombus aspiration can effectively improve infarction-related vascular flow and prognosis in the patients with STEMI and its safety is higher.