老年急性冠状动脉综合征患者急诊介入治疗中冠状动脉内应用替罗非班的临床观察

目的探讨对于行急诊经皮冠状动脉介入治疗(PCI)的老年急性冠状动脉综合征(ACS)患者,冠状动脉内应用替罗非班的有效性及安全性。方法选择行急诊PCI的老年ACS患者118例,随机分为对照组(静脉内使用替罗非班负荷量)和研究组(冠状动脉内使用替罗非班负荷量),每组各59例患者。比较两组PCI术后即刻冠状动脉造影结果,PCI术后7、30 d时主要不良心血管事件(MACEs)发生率间的差异。结果 PCI结束后共有115例患者入选。研究组(58例)与对照组(57例)比较,患者PCI术后梗死相关血管血栓积分(0.7±0.2比1.6±0.5,P<0.01)、TIMI血流分级(TIMI 3级:51%比41%,P<0.05)及TIMI心肌灌注分级(TMPG 3级:49%比38%,P<0.05)均明显改善,远端血管栓塞的发生率也明显降低(1.7%比14%,P<0.05)。PCI术后30 d时研究组患者的左心室射血分数较对照组明显改善(67.4±6.2)%比(60.7±4.6)%,P<0.05]。研究组PCI术后7 d时总MACEs的发生率明显低于对照组(3.5%比17.5%,P<0.05),但PCI术后30 d时两组总MACEs的发生率之间比较差异无统计学意义(1.7%比7.0%,P>0.05)。两组患者用药后出血并发症的发生率之间比较差异无统计学意义(P>0.05)。结论对于行急诊PCI的老年ACS患者,与静脉内使用替罗非班相比,冠状动脉内应用安全,且更有利于改善PCI术后冠状动脉血流、心肌灌注,7 d时MACEs发生率低于对照组,30 d时无明显差别。

Clinical value of intracoronary administration of bolus tirofiban during primary percutaneous intervention in elderly patients with acute coronary syndrome

Objective To investigate the efficacy and safety of intracoronary administration of bolus tirofiban during primary percutaneous coronary intervention （PCI） in elderly patients with acute coronary syndrome （ACS）. Methods A total of 118 elderly patients with ACS underwent primary PCI were enrolled and divided into study group （ intracoronary administration of bolus tirofiban, n = 59 ） and control group （ intravenous administration of bolus tirofiban, n = 59）. Angiographic characteristics, 7-day and 30-day major cardiovascular events （MACEs） after PCI were analyzed in both groups. Results Compared with control group, more patients in study group reached TIMI flow grade 3 （51% vs 41%, P 〈 0. 05） and TIMI myocardial perfusion grade 3 （49% vs 38%, P 〈 0. 05） immediately after PCI. Thrombus score of infarct-related artery （0. 7 ±0. 2 vs 1.6 ±0. 5, P 〈0. 01 ） and the incidence of distal embolism （ 1.7% vs 14% , P 〈 0. 05 ） were lower in study group than in control group immediately after PCI. Left ventricular ejection fraction in study group was greater than that in control group at 30-day （ 67.4 ± 6. 2 ） % vs （ 60. 7 ± 4. 6 ） %, P 〈 0. 05 ]. Incidence of composite MACEs at 7-day in study group was lower than that control group （3.5% vs 17.5%, P 〈0. 05）. The rate of bleeding was similar in two groups （ P 〉 0. 05 ）. Conclusions In elderly patients with ACS underwent primary PCI, compared with standard intravenous administration of bolus tirofiban, intracoronary administration of bolus tirofiban is safe and associates with superior coronary flow, myocardial infusion and short-term clinical outcomes.