急诊经皮冠状动脉介入术前与术中应用盐酸替罗非班对急性ST段抬高性心肌梗死患者有效性和安全性研究

目的 评价不同时机应用盐酸替罗非班在急性ST段抬高性心肌梗死(STEMI)患者急诊经皮冠状动脉介入(PCI)中的有效性和安全性。方法 将158例急性STEMI患者按入院顺序随机分为替罗非班治疗组1（确诊后立即静脉滴注盐酸替罗非班+ PCI，59例）、替罗非班治疗组2（冠状动脉内注射盐酸替罗非班+PCI，56例）和对照组（直接PCI，43例）。比较三组患者梗死相关动脉PCI术后即刻TIMI血流及远端栓塞情况，ST段抬高总和回落百分比（sum STR），PCI术后6、12h肌酸激酶同工酶(CK-MB)水平，术后1周左室射血分数(LVEF)，术后30d内严重心脏不良事件(MACE)发生率，出血发生率，术后血小板计数。结果 替罗非班治疗组1、替罗非班治疗组2 PCI术后即刻TIMI 3级血流发生率分别为98.3％( 58/59)和92.9％( 52/56)，均明显高于对照组的60.5％( 26/43)，差异有统计学意义(P＜0.05)；替罗非班治疗组1和替罗非班治疗组2 PCI术后90 min sum STR分别为(89.3±6.9)％和(82.4±7.3)％，与对照组的(65.6±8.1)％比较差异有统计学意义(P＜0.01)，且替罗非班治疗组1和替罗非班治疗组2比较差异也有统计学意义(P＜0.05)；替罗非班治疗组1和替罗非班治疗组2 PCI术后30 d内MACE发生率明显低于对照组(P＜0.05)；替罗非班治疗组1术后6、12 h CK-MB水平显著低于替罗非班治疗组2，替罗非班治疗组2低于对照组，差异均有统计学意义(P＜0.05)；替罗非班治疗组1术后1周LVEF(56.2±6.4)％]显著高于替罗非班治疗组2(51.1±4.9)％]和对照组(49.8±5.7)％](P＜0.05)，但替罗非班治疗组2与对照组比较差异无统计学意义(P＞0.05)。替罗非班治疗组1、替罗非班治疗组2 PCI术后皮肤黏膜出血率显著高于对照组，但均未发生严重出血和血小板减少症。结论 术前早期应用盐酸替罗非班能明显降低STEMI患者PCI术后缺血事件的发生，在急诊PCI中是有效而安全的。

Evaluation on safety and efficacy of tirofiban in patients with acute ST-elevation myocardial infarction undergoing emergency percutaneous coronary intervention

Objective To evaluate the safety and efficacy of tirofiba in the treatment of patients with acute ST-elevation myocardial infarction (STEMI) undergoing emergency percutaneous coronary intervention (PCI). Methods A total of 158 patients with acute STEMI were randomly divided into tirofiban group 1 (59 cases, received tirofiban before PCI), tirofiban group 2 (56 cases, received tirofiban when PCI) and control group (43 cases, only received PCI). The coronary reperfusion flow (TIMI grade) of infarct related artery (IRA) after PCI, the resolution of the sum of ST segment elevation (sum STR) at 90 min after the procedure, the changes of myocardial enzyme at 6 h and 12 h afterwards, the left ventricular ejection fraction (LVEF) 1 week later, the major adverse cardiac events(MACE) within 30 d, bleeding and thrombocytopenia complications were analyzed and compared among the three groups. Results TIMI reperfusion grades in tirofiban group 198.3％(58/59 )]and tirofiban group 292.9％(52/56)]were higher than those in control group60.5％(26/43)](P ＜0.05). The resolution of sum STR at 90 min after PCI in tirofiban group 1 (89.3 ± 6.9)％]and tirofiban group 2(82.4 + 7.3)％]was higher than that in control group(65.6 +8.1 )％](P＜ 0.01 ),and there was significant difference between tirofiban group I and tirofiban group 2 (P＜0.05 ). The occurrence of MACE within 30 d was lower in tirofiban group 1 and tirofiban group 2 than that in control group (P＜ 0.05). The level of CK-MB at 6 h and 12 h afterwards was lower in tirofiban group 1 than that in tirofiban group 2,and tirofiban group 2 was lower than control group (P＜ 0.05). LVEF 1 week later in tirofiban group 1(56.2 + 6.4)％]was higher than that in tirofiban group 2(51.1 + 4.9)％]and control group(49.8 + 5.7)％](P ＜ 0.05),but there was no significant difference between tirofiban group 2 and control group (P ＞ 0.05). Although bleeding incidence in tirofiban group 1 and tirofiban group 2 was higher than that in control group, no severe bleeding and thrombocytopenia was observed. Conclusion Tirofiban can safely and effectively reduce the incidence of the ischemic events in the patients with acute STEM1 during preoperative of emergency PCI.