替罗非班对急性心肌梗死患者高水平血小板聚集率和预后的影响

目的 观察替罗非班在择期经皮冠状动脉介入治疗(PCI)急性心肌梗死患者应用过程中的高水平血小板聚集率(＞40%),及其与临床结果的关系.方法 收集2007年6月至2009年6月在河南省人民医院行择期行经皮冠状动脉介入治疗(PCI)的急性ST段抬高心肌梗死患者资料,满足术后12 h血小板聚集率＞40%的共140例,术后应用替罗非班组72例,未应用替罗非班的对照组68例.替罗非班的应用方法为PCI术后即刻静脉注射替罗非班10μg/kg(3 min注完),然后以0.1 μg/(kg·min)静脉滴注维持36 h.所有患者均接受皮下注射低分子肝素及口服二磷酸腺酐(ADP)受体拮抗剂和阿司匹林.观察两组患者7 d、30 d和6个月复合终点事件发生率(死亡、顽固性心肌缺血、再发心肌梗死和靶血管重建术)和出血事件.结果 替罗非班组与对照组7 d、30 d复合终点事件发生率差异无统计学意义(2.7%vs 1.5%,P＞0.05;6.9%vs 4.4%,P＞0.05);6个月复合终点事件发生率替罗非班组明显高于对照组(19.4%vs7.4%,P＜0.05).替罗非班组出血事件有增多趋势(11.1%vs 7.4%,P＞0.05),主要是穿刺点出血,两组均无颅内出血等严重出血事件发生.结论 行择期PCI的急性心肌梗死患者,替罗非班应用过程中血小板聚集率处于较高水平(40%以上)者,6个月心血管不良事件发生率增加.Abstract：Objective To observe the relationship between high (above 40% ) platelet aggregation rate(PAR) and clinical outcomes in ST segment elevation myocardial infarction(STEMI) patients undergoing selective percutaneous coronary artery intervention (PCI) after utiliity of tiroban. Methods The clinical materials of 140 STEMI patients with platelet aggregation rate above 40% at 12 hours after selective PCI in the People Hospital of Henan Province from June 2007 to June 2009 were collected, in which 72 patients received tirofiban 10 μg/kg by intravenous injection within 3 minutes immediately after PCI, followed by pump infusion at 0. 10 μg/( kg· min) for 36 hours and 68 patients as the control group received no tirofiaban therapy after PCI. All patients received subcutaneous low molecular heparin injection and oral ADP receptor antagonist and aspirin. Incidence of 7,30 days and 6 months composite end point events (death persistent myocardial ischemic, reinfarction and target vessel revascularization) and bleeding complications were observed in both groups. Results The 7 and 30 days end point events rates of the two groups showed no significant differences(2.7% vs 1.5%, P ＞0.05 ;6.9% vs 4.4%, P ＞0. 05, respectively) , but the 6 months end point events rates of tirofiban group was significant higher than that of the control group( 19.4% vs 7.4%, P ＜ 0.05 ). Bleeding complications occurred more frequently in the tirofiban group ( 11.1% vs 7.4% , P ＞ 0.05 ), mostly at the arterial puncturing site, but there was no intracranial hemorrhage in either group. Conclusions Myocardial infarction patients with higher platelet aggregation( above 40% ) after selective PCI, whom received tirofiban therapy,may have a higher cardiac events rates in the long term.

The effect of tirofiban on high platelet aggregation rate and prognosis of patients with myocardial infarction undergoing selective percutaneous coronary artery intervention

Myocardial infarction Percutaneous coronary artery intervention Platelet aggregation rate Tirofiban