早期应用替罗非班对ST段抬高性心肌梗死患者行急诊经皮冠状动脉介入治疗后的疗效简

目的 探讨早期应用替罗非班对ST段抬高性心肌梗死（ST segment elevation myocardial infarction,STEMI）患者急诊经皮冠状动脉介入（percutaneous coronary intervention,PCI）治疗疗效的影响.方法 自2009年1月至2012年1月,将186例接受急诊PCI治疗的STEMI患者分为2组：A组为实验组,为早期应用替罗非班的患者共95例,均于PCI治疗前使用;B组为对照组,常规治疗组,未使用替罗非班的患者共91例.分析两组PCI治疗前、后的临床状况、造影血流情况心肌梗死溶栓（thrombolysis in myocardial infarction,TIMI）血流分级、TIMI心肌灌注分级（TIMI myocardial perfusion,TMP）]及出血事件.记录住院期间及随访6个月内的主要心血管事件的发生率.结果 所有患者均成功行急诊PCI治疗.两组间的基础临床情况及术前造影情况比较,差异无统计学意义（P＞0.05）.与B组比较,A组PCI治疗后TIMIⅢ级血流的比例（96.5％ vs.81.2％,P＜0.05）、TMPⅡ级以上血流的比例（96.8％ vs.84.2％,P＜0.05）均明显增高,发生无复流现象的比例（5.6％ vs.13.2％,P＜0.05）则明显减少,差异均有统计学意义.两组住院期间主要心血管事件、出血事件的发生率比较,差异无统计学意义（P＞0.05）.而在随访的6个月期间内,A组主要心血管事件较B组明显减少,差异有统计学意义（P＜0.01）.结论 在STEMI急诊PCI治疗患者中,早期应用替罗非班能有效预防无复流现象的发生,改善靶血管前向血流,挽救更多存活心肌及改善预后.

Effect of pretreatment with tirofiban in patients with ST-segment elevation myocardial infarction receiving emergency percutaneous coronary intervention

Objectives To investigate the effect of pretreatment with tirofiban in patients with ST-segment elevation myocardial infarction （STEMI） receiving emergency percutaneous coronary intervention （PCI）.Methods From January 2009 to January 2012,186 patients with STEMI receiving emergency PCI were randomly divided into tirofiban group （group A,95 cases,used tirofiban before PCI as early as possible） and control group （group B,91 cases,treated with conventional treatment without tirofiban）.Basic clinical characteristics,angiographic outcomesthrombolysis in myocardial infarction （TIMI）,blood flow grade and TIMI myocardial perfusion （TMP） grade],PCI efficiency and bleeding events before and after PCI were compared between the two groups.Major adverse cardiac events （MACEs） were also recorded in hospital and during 6 months＇ follow-up.Results There was no significant difference between the two groups in basic clinical characteristics and preoperative angiographic features （P＞0.05）.Compared with group B,the rates of final TIMI flow grade Ⅲ and TMP over grade Ⅱ were significantly higher in group A （96.5％ vs.81.2％,P＜0.05; 96.8％ vs.84.2％,P＜0.05）,while the rate ofno-reflow phenomenon was obviously lower （5.6％ vs.13.2 ％,P＜0.05）.There were no significant differences in MACEs and bleeding events in hospital between the two groups （P＞0.05）.MACEs in group A during the follow-up period of the 6 months significantly reduced compared with those in group B （P＜0.01）.Conclusions Pretreatment with tirofiban in patients with STEMI receiving emergency PCI can effectively prevent no-reflow phenomenon and improve coronary blood perfusion,save more viable myocardium,and improve the prognosis.