摘要
目的评价国产血小板膜糖蛋白(GP)Ⅱb/Ⅲa受体拮抗剂替罗非班对急性ST段抬高性心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)后心肌灌注及安全性的影响。方法2005年1月至2006年12月发病12h内接受急诊PCI术的STEMI患者中,符合术前梗死相关血管(IRA)完全闭塞(TIMI0或1级)、术后前向血流达到TIMI3级的患者共71例,分为替罗非班组(n=36)和对照组(n=35)。比较两组基础临床特征、心肌呈色分级(MBG)及术后90min心电图ST段回落百分比(sumSTR),并观察住院期间主要心血管事件、左室射血分数及出血并发症。结果两组基础临床情况和造影特征无明显差异。替罗非班组心肌呈色分级3级获得率明显增高(69·4%比37·1%,P=0·01),术后90minsum STR(60·6%±26·7%比42·2%±35·3%,P=0·03)和ST段完全回落(sumSTR≥70%)的比例(61·1%比28·6%,P=0·02)均显著高于对照组。替罗非班组心肌梗死后1周射血分数也明显高于对照组(55·2%±5·2%比51·3%±7·3%,P=0·03)。两组住院期间主要心血管事件发生率差异无统计学意义。替罗非班组轻度出血发生率有高于对照组趋势(16·7%比5·7%,P=0·26),但无严重出血或血小板减少症。结论国产替罗非班能改善急诊PCI术后心肌灌注指标,并有助于改善心功能。急诊PCI联合使用替罗非班治疗是安全可行的。
Objective To investigate the effect of glycoprotein 11 b/m a receptor blockade with tirofiban on myocardial perfusion in patients with ST-segment elevated myocardial infarction （STEMI） undergoing primary percutaneous coronary intervention （PCI）. Methods Seventy one patients who presented with acute STEMI within 12 hours from onset and received successful primary PCI between January 2005 to December 2006 were enrolled into the study. All patients had angiographic evidence of initial total occlusion of infarct-related artery and finally restored to TIMI 3 flow after PCI. All the patients were grouped into the tirofiban group （n = 36） and the control group （n = 35） according to whether tirofiban was used or noL Assessment of myocardial perfusion included Myocardial Blush Grades （MBG）, and the resolution of the sum of ST-segment elevation （sumSTR） at 90 minutes after the procedure. Left ventricular ejection fraction （EF） was measured one week later. Major adverse cardiac events in hospital and bleeding complications were also assessed. Results Baseline clinical and angiographic characteristics of the two groups were similar. Significant higher rates of MBG 3 were observed in the tirofiban group （69.4% vs 37. 1%, P = 0.01 ）. Patients received tirofiban were more likely to achieve higher sumSTR （60. 6% ± 26.7% vs 42.2% ±35.3% ,P =0. 03） and complete ST resolution （sumSTR≥70%） （61.1% vs 28.6%, P = 0. 02）. Ejection fraction was also increased markedly in tirofiban group than the control group （55.2% ±5.2% vs 51.3%±7.3% ,P =0. 03）. In-hospital major adverse cardiac events were not different between the two groups. There were slightly more minor bleeding complications in the tirofiban group compared with the control （ 16. 7% vs 5.7%, P =0. 26）. No patient had major bleeding or thrombocytopenia. Conclusion Tirofiban can further ameliorate microvascular perfusion and is safe and feasible for patients with STEMI undergoing primary PCI.
出处
《中国介入心脏病学杂志》
2007年第4期210-213,共4页
Chinese Journal of Interventional Cardiology
基金
江苏省重大科技示范工程项目(BS2003003)"心脑血管疾病规范化治疗"资助
关键词
心肌梗死
血管成形术
经腔
经皮冠状动脉
血小板膜糖蛋白类
替罗非班
Myocardial infarction
Angioplasty, transluminal, percutaneous coronary
Platelet membrane glycoproteins
Tirofiban
