替罗非班对急诊冠状动脉介入治疗后ST段回落不良的急性前壁心肌梗死患者预后的影响

目的 探讨血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂替罗非班对直接经皮冠状动脉介入治疗后出现ST段回落不良的急性前壁心肌梗死患者预后的影响.方法 2006年4月至2008年4月共入选157例急性前壁心肌梗死患者,随机将患者分为两组.治疗组(80例)在术后1 h应用替罗非班(10μg/kg静脉推注后,以0.15μg·kg-1·min-1持续48 h),对照组(77例)不应用替罗非班.比较两组的基线临床状况,住院期间出血事件,出院后30 d和6个月的主要不良心血管事件(MACE,包括死亡、再次心肌梗死和再次靶病变血管重建)发生率及左心室射血分数.结果两组的基线临床情况差异无统计学意义.与对照组比较,治疗组出院后30 d的MACE发生率显著降低(6.3%比18.2%,P＜0.05),其中再次心肌梗死发生率的降低也具有统计学意义(1.3%比9.1%,P＜0.05).治疗组6个月的MACE发生率和再次心肌梗死发生率显著降低(分别为10.0%比23.4%,P＜0.05;2.5%比10.4%,P＜0.05),治疗组出院后30 d,6个月的左心室射血分数均显著高于对照组分别为(51±6)%比(46±8)%,P＜0.05;(57 4-7)%比(50±9)%,P＜0.05].两组的出血和血小板减少症发生率差异无统计学意义.结论替罗非班可以显著降低直接经皮冠状动脉介入治疗后ST段回落不良的急性前壁心肌梗死患者的30 d和6个月MACE发生率,改善其30 d和6个月的心功能,同时不增加出血事件.

Effect of tirofiban in acute anterior myocardial infarction patients without ST segment resolution after primary percutaneous coronary intervention

Objective To observe the effect of glycoprotein receptor blockade tirofiban in acute anterior myocardial infarction patients without ST segment resolution after primary percutaneous coronary intervention (PCI). Methods From April 2006 to April 2008, 157 acute anterior myocardial infarction patients without ST segment resolution after PCI were randomly allocated to tirofiban (intravenous bolus 10 fig/kg followed by intravenous infusion of 0. 15 μg·kg-1·min-1 for 48 h, n =80) or equal volume saline (control group, n =77). Baseline characteristics, PCI features and clinical outcomes during hospitalization, left ventricular ejection fractions (LVEF) and major adverse cardiac events (MACE, including death, re-infarction and target vessel revascularization) at 30 and 180 days after discharge were compared between the two groups. Results The baseline clinical characteristics were comparable between the two groups. Compared to control group, the MACE rates and re-infarction rates at 30 days (6. 3% vs. 18. 2% , P < 0.05; 1.3% vs. 9. 1%, P<0.05, respectively) and 180 days (10.0% vs. 23. 4% , P<0.05; 2.5% vs. 10.4% , P < 0. 05, respectively ) were significantly reduced in tirofiban group. LVEF value was significantly higher in tirofiban group at 30 days and 180 days compared with those in control group (51 ± 6)% vs. (46±8)%, P<0.05; (57±7)% vs. (50±9)%, P<0.05]. Hemorrhagic complications were similar between the two groups. Conclusion Use of tirofiban for acute anterior myocardial infarction patients without ST segment resolution after PCI is safe and can significantly improve 30 and 180 days clinical outcomes after discharge.