替罗非班易化PCI术对不稳定型心绞痛患者疗效的临床观察

目的:初步评价经皮冠状动脉介入(PCI)治疗不稳定型心绞痛(UAP)应用替罗非班易化的有效性和安全性。方法:80例接受PCI治疗的中高危UAP患者,随机分为替罗非班组(38例)和对照组(42例)。对照组未使用替罗非班,替罗非班组患者入院时即静脉应用并于PCI术后持续静滴注36h,比较2组基础临床情况、支架置入数及靶血管置入支架后血流TIMI分级、血流速度、校正的TIMI帧数(CTFC)及出血并发症和术后30d主要心血管不良事件(MACE)。结果:2组的基础临床情况差异无统计学意义。与对照组相比,术后替罗非班组中靶血管的TIMI 3级血流获得率更高,但差异无统计学意义(88.00%∶73.91%,P>0.05);无复流发生率明显减少,差异具有统计学意义(4.00%∶17.39%,P<0.05);替罗非班组的血流速度明显增快[(137.12±19.65)mm/s∶(123.46±21.35)mm/s,P<0.01];CTFC减小[(20.36±2.52)帧∶(24.52±3.43)帧,P<0.01]。2组的出血并发症和术后30dMACE发生率差异无统计学意义。结论:对于中高危UAP患者行PCI,早期使用替罗非班能显著减少无复流现象,提高前向血流,改善术后心肌灌注,并不增加出血风险,临床应用安全。

Percutaneous coronary intervention combined with ultra-early tirofiban therapy in patients with unstable angina pectoris

Objective:To investigate the clinical effects of percutaneous coronary intervention(PCI) combined with ultra-early tirofiban therapy in patients with unstable angina pectoris(UAP). Method:Eighty patients with moderate or high risk UAP were randomly allocated to either tirofiban and PCI(tirofiban group,n=38) or primary PCI alone(control group,n=42).Not only baseline characteristics,TIMI grade of target artery after PCI and the number of stent between 2 groups were observed,but also the angiogcaphic features,such as blood flow velocity of target artery,corrected TIMI frame count(CTFC) were analyzed at the end of PCI.Bleeding complications and the incidence of major adverse cardiac events(MACE) at 30 days after PCI were also compared. Result:There was no difference of baseline clinical characteristic between the two groups.Compared with the control group,the tirofiban group had more higher rate of TIMI grade 3 after PCI,but had no significant difference(88.00% vs 73.91%,P>0.05).However,the no-reflow phenomenon were reduced obviously(4.00% vs 17.39%,P<0.05).Blood flow velocity was more swift in the tirofiban group than that in the control group([137.12±19.65]mm/s vs [123.46±21.35]mm/s,P<0.01) after PCI.CTFC immediately was lower in the front group([20.36±2.52] vs [24.52±3.43],P<0.01).The occurrence of bleeding and MACE at 30 days after PCI were similar between the two groups(P>0.05). Conclusion:Ultra-early tirofiban therapy for patients with moderate or high risk UAP who undergo PCI is safe and improves coronary flow of target atery and myocardial reperfusion.Useness of tirofivan has no more risk for bleeding complications.