急性ST段抬高型心肌梗死急诊介入治疗中冠状动脉联合静脉内应用替罗非班的临床研究

目的探讨对于行急诊经皮冠状动脉介入治疗(PCI)的急性ST段抬高型心肌梗死(STEMI)患者,静脉联合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STEMI患者66例,随机分为对照组(单纯早期静脉内使用替罗非班)和研究组(静脉联合冠状动脉内使用替罗非班),每组各33例患者。比较2组PCI术后血清肌钙蛋白T(cTnT)和肌酸激酶同工酶(CK-MB)水平、心电图ST段回落率、梗死相关动脉的血流分级及心肌组织的再灌注情况、左心室射血分数(LVEF)、PCI术后30 d主要不良心血管事件(MACEs)发生率的差异。结果研究组术后血清cTnT、CK-MB水平显著低于对照组(P<0.05)。研究组术后ST段回落率、TIMI血流III级获得率及TMPG III级获得率均显著高于对照组(P<0.05)。2组PCI术后7d的LVEF之间比较无统计学差异(P>0.05)。研究组总MACEs的发生率显著低于对照组(9.68%vs 34.4%,P<0.05)。2组患者用药后出血并发症的发生率之间比较无统计学差异(P>0.05)。结论对于行急诊PCI的STEMI患者,与单纯早期静脉使用替罗非班相比,冠脉和静脉内联合使用安全,且更有助于改善冠脉血流、心肌灌注和短期预后。

Effect of Intracoronary Bolus Administration of Tirofiban for Patients With Acute ST-segment Elevation Myocardial Infarction During Primary Percutaneous Coronary Intervention

Objective To investigate the efficacy and safety of intravenous plus intracoronary administration of tirofiban for patients with acute ST-segment elevation myocardial infarction(STEMI) during primary percutaneous coronary intervention(PCI).Methods Sixty-six patients were treated with primary PCI for STEMI.Patients received either intravenous administration of tirofiban(control group,n=33) or intravenous plus intracoronary administration of tirofiban(study group,n=33).The levels of serum cardiac troponin T(cTnT) and creatine phosphokinase MB isoenzyme(CK-MB),ST resolution in electrocardiogram,angiographic characteristics,left ventricular ejection fraction(LVEF),30 d major cardiovascular events(MACEs) after PCI were analyzed in the 2 groups.Results The levels of cTnT and CK-MB were lower(P<0.05) in the study group(n=32) than the control group(n=31).The ratio of 50% ST resolution,TIMI flow grade(TIMI) III and TMI myocardial perfusion grade(TMPG) III were higher in the study group than the control group(P<0.05).There was no significant difference in LVEF between the 2 groups(P>0.05) 7 d following PCI.The 30 d composite MACEs rate was lower in the study group than the control group(9.68% vs 34.4%,P<0.05).There were no significant differences in the rates of bleeding complications and plaque decrease between the 2 groups(P>0.05).Conclusion In patients with STEMI undergoing primary PCI,intravenous plus intracoronary administration of tirofiban is safe and associated with superior coronary flow,myocardial infusion and short-term clinical outcomes compared with the standard early intravenous administration of tirofiban.