替罗非班联合血栓抽吸导管预处理对ST段抬高型心肌梗死患者即刻或择期经皮冠状动脉介入治疗的影响

目的：研究替罗非班联合血栓抽吸导管预处理对急性ST段抬高型心肌梗死（STEMI）患者即刻或择期经皮冠状动脉介入（PCI）治疗的临床疗效和安全性的影响。方法：纳入102例经急诊冠状动脉造影显示罪犯血管前向血流TIMI 0级，且伴有明显血栓负荷影像的STEMI患者。应用替罗非班联合血栓抽吸导管预处理至前向血流恢复TIMI3级后．随机分为即刻PCI治疗组（n=52）及择期（7～10d后）PCI治疗组（n=50）。比较两组患者冠脉支架植入情况，PCI治疗中慢血流或无复流事件发生率，住院期间主要心血管事件发生率及PCI治疗后4周左室射血分数（LVEF）。结果：择期PCI治疗组冠脉支架植入成功率显著高于即刻PCI治疗组（100％哪86．54％，P〈0．05），且使用支架数量较少；即刻PCI治疗组治疗中慢血流或无复流事件的发生率为9．62％。择期PCI治疗组无1例发生，差异有统计学意义（P〈0．05）：即刻PCI治疗组患者住院期间主要心血管事件发生率为7．69％，择期PCI治疗组为0，差异有统计学意义（P〈0。05）；PCI治疗后4周两组患者LVEF比较差异无统计学意义（P〉0．05）。结论：经替罗非班联合血栓抽吸导管预处理迭TIMI3级血流的STEMI患者行后续择期PCI治疗比即刻PCI治疗有更好的临床疗效．且安全性明显提高。

Effects of precondiioning with tirofiban and thrombus aspiration catheter upon immediate or selective percutaneous coronary intervention in patients with ST segment elevation myocardial infarction

Objective： To study the efficacy and safety of preconditioning of tirofiban and thrombus aspiration catheter upon immediate or selective percutaneous coronary intervention （PCI） in patients with ST segment elevation myocardial infarction （STEMI）. Methods： We included 102 patients with STEMI displaying TIMI grade 0 forward flow of the culprit vessel and marked thrombus load images in the coronary angiography. Following preconditioning with tirofiban and thrombus aspiration catheter that drove the forward flow to recover to TIMI grade 3, patients were randomly allocated to immediate （n =52） and selective （7 -10 days thereafter） PCI treatment group （ n = 50）. This entailed the comparison on the need for coronary stent implantation, the incidence rate of slow blood flow or no reflow event during PCI, the incidence of major cardiovascular events during hospitalization and the left ventricular ejection fraction （LVEF） at week 4. Results： The success rate of coronary stent implantation and the consumption of coronary stents in selective PCI treatment group was markedly higher and reduced than those in immediate PCI treatment group （ 100% vs 86. 54%, P 〈 0.05）. The incidence rate of slow blood flow or no reflow event in the immediate PCI treatment group was markedly higher than in selective PCI treatment group （9.62% vs. 0.0%, P 〈0.05）. A similar pattern applied to the incidence rate of major cardiovascular events during hospitalization （7.69% vs 0, P 〈 0.05 ）. There was no significant difference in LVEF at week 4 （ P 〉 0. 05 ）. Conclusion： Compared with immediate PCI treatment, the selective PCI treatment is superior in terms of efficacy and safety in STEMI patients with blood flow of TIMI grade 3 or less following preconditioning with tirofiban and thrombus aspiration catheter.