老年急性心肌梗死患者急诊介入治疗联合应用替罗非班的安全性分析

目的探讨老年急性心肌梗死(AMI)患者急诊经皮冠状动脉介入治疗(PCI)联合应用替罗非班的安全性。方法150例AMI患者行急诊PCI时联合应用替罗非班。按年龄≥65岁和<65岁将患者分为老年组(40例)和非老年组(110例),分析两组患者出血并发症和血小板减少症的发生情况。并根据是否达到心肌梗死溶栓试验(TIMI)出血标准将患者分为TIMI出血组(10例)和非TIMI出血组(140例),分析出血的相关危险因素。结果老年组达到TIMI出血标准的发生率有高于非老年组的趋势(12.5%vs4.5%,P=0.132)。logistic多因素分析提示仅有术后即刻的活化部分凝血酶原时间值是发生TIMI出血事件的独立危险因素(P=0.013,OR=1.458)。两组血小板减少症发生率无显著差异(0vs2.7%,P=0.565)。结论在≥65岁的老年AMI患者中,急诊PCI联合应用替罗非班是安全的。

Safety of tirofiban in elderly patients with acute myocardial infarction treated with primary percutaneous coronary intervention

Objective To assess safety of tirofiban in elderly patients with acute myocardial infarction(AMI) treated with primary percutaneous coronary intervention(PCI).Methods 150 AMI patients received tirofiban during primary PCI.The patients were divided into elderly group(40 cases aged 65 years or older) and non-elderly group(110 cases younger than 65 years).Hemorrhagic complications and related clinical features in the two groups were analyzed retrospectively,and hemorrhagic complications were evaluated according to TIMI criteria.Results Compared with patients in non-elderly group,there was a trend of higher incidences of TIMI major and minor bleeding complications in elderly group,but there was no statistically significant difference between two groups.Multivariate logistic regression analysis revealed that high APTT was the only independent risk factor for TIMI major or minor bleeding complications(P=0.013,OR=1.458).There was no significant difference between the two groups in the incidences of thrombocytopenia(0 vs 2.7%,P=0.565).Conclusions According to the initial clinical data,application of tirofiban in elderly patients aged 65 years or older with AMI treated with primary PCI was safe.