冠脉内注射高剂量替罗非班对急性ST段抬高型心肌梗死直接PCI术后碎裂QRS波的影响

目的探讨冠脉内注射高剂量替罗非班对急性ST段抬高型心肌梗死(STEMI)直接经皮冠状动脉介入(PCI)治疗术后体表心电图出现碎裂QRS波(f QRS)的影响。方法连续入选150例接受直接PCI治疗的急性STEMI患者,随机分成冠脉内注射高剂量替罗非班组(替罗非班组,n=75)和常规治疗组(n=75),观察住院48 h内体表心电图f QRS的发生率以及术后住院期间主要不良心脏事件(MACE)。结果两组临床基本特征无显著差别。替罗非班组术后校正的TIMI帧数(CTFC)较常规组少(23±7)帧vs.(30±10)帧,P0.05];肌酸激酶同工酶(CK-MB)峰值浓度显著低于常规治疗组(245±162)U/L vs.(311±180)U/L,P0.05],而左心室射血分数(LVEF)值则显著高于常规治疗组(51±6)%vs.(47±7)%,P0.05],同时,术后替罗非班组和常规治疗组f QRS发生率分别41%(30/75)和57%(43/75),两组之间比较差异显著,P0.05)。两组住院期间MACE事件有差异,但未达到统计学意义(5%vs.12%)。结论冠脉注射高剂量替罗非班能改善心肌灌注,降低术后体表心电图f QRS发生率,提高心脏功能。

Effect of intracoronary injection of high-dose tirofiban on fragmented QRS complexes in patients with acute ST segment elevation myocardial infarction after primary percutaneous coronary intervention

AIM To investigate the effect of intracoronary injection high-dose tirofibann on the fragmented QRS complexes (fQRS) in patients with acute ST segment elevation myocardial infarction (STEM) after primary percutaneous coronary intervention (PCI). METHODS One hundred fifty acute STEMI patients enrolled continuously in the study were divided into high-dose tirofiban group (tirofiban group) and routine treatment group (routine group). The changes of fQRS on electrocardiogram and the MACE events were observed within 48 hours after primary PCI. RESULTS A total of 150 patients (aged 35-83 years; male, 82.7%) were included in the study and the baseline clinical characteristics were comparable between the two groups. Compared with patients in routine group, patients in the tirofiban group had lower levels of creatine kinase-MB ［(245±162) U/L vs. (311±180) U/L, P<0.05］ and corrected TIMI Frame Count (CTFC) post-PCI ［(23±7) vs. (30±10), P<0.05］, but higher left ventricular ejection fraction (LVEF) ［(51±6)% vs. (47±7)%, P<0.05］. The incidence of presence of fQRS on electrocardiogram in tirofiban group was lower than that in routine group (41% (30/75) vs. 57% (43/75), P<0.05). In Spearman’s correlation analysis, the level of CK-MB showed positive correlation with the number of leads with fQRS (r=0.207, P<0.05), but LVEF showed negative correlation with the number of leads with fQRS (r=-0.242, P<0.01). Multivariate analysis revealed that the intracoronary injection of high-dose tirofiban was the negative predictor of fQRS (Wald=4.257, OR: 0.364, 95% CI 0.139-0.95, P<0.05). There were differences in MACE events between the two groups during hospitalization, but the differences were not statistically significant (5.3% to 12%. t=3.63). CONCLUSION High-dose intracoronary injection of tirofiban can help to improve myocardial perfusion, reduce postoperative the presence of fQRS appearing on the standard 12-lead ECG and enhance cardiac functions.