国产替罗非班对老年急性冠脉综合征介入治疗患者近远期预后的影响

目的 评价国产替罗非班对老年急性冠脉综合征(ACS)接受经皮冠状动脉介入治疗(PCI)患者近期和远期预后的影响.方法 选择接受PCI治疗的325例年龄≥60岁的ACS患者,根据是否使用替罗非班分为替罗非班组(210例)和对照组(115例).两组患者术中均植入药物洗脱支架,口服阿司匹林+氯吡格雷;替罗非班组在此基础上加用替罗非班.比较两组基线资料,支架植入即刻心肌梗死溶栓血流(TIMI)3级的比例,支架内血栓发生率,轻微出血、大出血和血小板减少发生率,术后30 d和12个月的病死率、心肌梗死(心梗)和靶血管血运重建(TVR)的发生率.结果 替罗非班组PCI后即刻TIMI血流3级的比例高于对照组(99.05％比94.78％,P＜0.05),支架内血栓发生率明显低于对照组(0.47％比2.61％,P＜0.05)；替罗非班组术后30 d和12个月病死率、心梗和TVR发生率明显低于对照组(30 d:0、0.47％、0.47％比2.61％、3.48％、2.61％;12个月:0、0.47％、0.47％比2.61％、5.22％、5.22％,P＜0.05或P＜0.01)；替罗非班组轻微出血发生率高于对照组,但差异无统计学意义(7.14％比4.35％,P＞0.05)；两组均无大出血病例；替罗非班组血小板减少发生率较对照组有所升高(0.95％比0,P＞0.05).结论 国产替罗非班可明显改善老年ACS患者PCI术后即刻TIMI血流状况,有效降低支架内血栓发生率,减少术后30 d和12个月的病死率及心梗和TVR发生率,且不增加大出血和血小板减少的发生,从而改善患者的近期和远期预后.

Tirofiban improved the prognosis of scenior acute coronary syndrome patients received percutaneous coronary intervention

Objective To examine if tirofiban may improve the prognosis in aged acute coronary syndrome(ACS)patients received percutaneous coronary intervention(PCI).Methods Three hundred and twenty-five ACS patients(age ≥60 years),all received drug-eluting stents implantation,were assigned into tirofiban group(n =210)to receive tirofiban+aspirin and clopidogrel and control group(n=115)to received aspirin and clopidogrel only.The incidence of thrombolysis in myocardial infarction(TIMI)grade 3 after PCI,in-stent thrombosis,slight/severe bleeding,platelet decrease,myocardial infarction(MI)and target vessel revascularization(TVR)within 30 days and 12 months after PCI and 30 days and 12 months mortality post PCI.Results In comparison with the control group,the tirofiban group had significantly higher TIMI grade 3 flow after PCI(99.05％ vs.94.78％,P＜0.05),lower in-stent thrombosis(0.47％ vs.2.61％,P＜0.05),as well as lower mortality,MI,and TVR in 30 days and 12 months after PCI(30 days:0,0.47％ and 0.47％ vs.2.61％,3.48％ and 2.61％; 12months:0,0.47％ and 0.47％ vs.2.61％,5.22％ and 5.22％,P＜0.05 or P＜0.01).No significant difference was found(both P＞0.05)in slight bleeding (7.14％ vs.4.35％)and severe bleeding(0 vs.0)between tirofiban group and control group.A slight difference in thrombocytopenia was found between tirofiban group and control group(0.95％ vs.0),but it failed to reach the level of statistical significance(P＞0.05).Conclusions Tirofiban may improve the TIMI grade flow in senior ACS patients after PCI.It also decreases the incidence of in-stent thrombosis,mortality,MI,and TVR in 30 days and 12 months after PCI,without causing increase in severe bleeding and plateletpenia.Therefore,it may improve the short/long-term prognosis for these patients.