目的:探讨替罗非班对直接经皮冠状动脉介入治疗(PCI)的急性心肌梗死(AMI)患者心肌灌注及临床预后的影响.方法:将AMI住院患者60例随机分为替罗非班治疗组(A组,予直接PCI+替罗非班,n=30)和对照组(B组,仅予直接PCI,n=30).比较两组间的基础临床状况、造影情况、介入治疗结果、心功能和心脏不良事件(MACE,包括死亡、再梗死、再次靶血管重建)发生率.结果:两组基础临床情况、介入治疗结果差异均无统计学意义.与B组相比,A组术后即刻心肌梗死溶栓试验(TIMI)3级复流血流差异无统计学意义(93% vs 86%,P>0.05).即刻心肌Blush分级3级(77.0%vs 33.0%,P<0.05)显著高于B组,而校正TIMI帧数[(23.5± 7.6)帧和(32.1±4.2)帧,P<0.05]显著低于B组.A组术后ST段抬高总和回落[(69.8±14.2)%和(38.6±11.7)%,P<0.05]显著高于B组,而肌酸激酶(CK)峰值[(28.4±5.0)和(37.7±8.7)μkat/L,P<0.05]显著低于对照组.住院期间,A,B两组左室射血分数(LVEF)[(45.8 ± 2.7)%和(44.7±3.8)%]、左室舒张期末直径(LVEDD)[(4.95±0.31)cm和(4.99 ± 0.27)cm]差异均无统计学意义.随访期间,A,B两组LVEF[(58.1 ± 3.6)%和(51.1±2.4)%]、LVEDD[(5.2±0.2)cm和(5.5±0.2)cm]差异均有统计学意义(P<0.05).两组住院期间和随访期间各项心脏事件发生率差异有统计学意义(P<0.05).A组术后出血并发症发生率高于B组(23.3% vs 7.0%),但差异无统计学意义(P > 0.05).结论:替罗非班可改善PCI的AMI患者心肌灌注及临床预后,且临床应用安全.
Comparative study of primary percutaneous coronary intervention and Tirofiban combined with percutaneous coronary intervention in treatment of patients with acute myocardial infarction
AIM: To investigate the effect of glycoprotein IIb/IIIa receptor blockade with tirofiban on the clinical outcomes and myocardial blush perfusion recovery in acute myocardial infarction (AMI) patients treated by primary percutaneous coronary intervention (PCI). METHODS: Sixty AMI patients were randomized to receive either tirofiban plus primary PCI (group A, n = 30) or primary PCI alone (group B, n = 30). Baseline characteristics, results of primary PCI, cardiac function and the incidence of cardiac events were compared between the 2 groups. RESULTS: No significant difference was observed between the 2 groups in basic clinical or angiographic characteristics before PCI and in the percentage of TIMI 3 flow achieved in infarction related arteries (IRAs) after PCI (P ＞ 0.05, respectively). Fewer TIMI frames [(23.5 ± 7.6) frames us (32.1 ± 4.2) frames, P ＜ 0.05] and higher percentage of blush grade 3 of IRAs (77.0% vs 33.0%, P ＜ 0.01) were observed in tirofiban group. Follow-up data before hospital discharge showed lower peak serum CK levels [(28.4 ± 5.0)μkat/L,(37.7 ± 8.7) μkat/L, P ＜ 0.05] and faster ST segment resolution in the tirofiban group after PCI [(69.8 ± 14.2)% vs (38.6 ± 11.7)%, P ＜ 0.05]. During hospital stay, no significant difference in LVEF and LVEDD was observed between the two groups (both, P ＞ 0.05) but significant difference was found during follow-up period (both, P ＜ 0.05). No significant difference in postoperative bleeding-related complications was found between the 2 groups (P ＞ 0.05), but the main adverse cardiac events (MACE) between the 2 groups were significantly different (P ＜ 0.05). CONCLUSION: Adjutant therapy with tirofiban is safe and effective for patients with acute myocardial infarction who undergo primary PCI. Tirofiban improves the clinical outcomes and myocardial blush perfusion after PCI.
NETL
NSTL
万方数据
维普
