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冠脉内注射盐酸替罗非班在急性STEMI 急诊PCI中应用的有效性及安全性(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2008年第6期
页码:
714-715719
栏目:
临床研究
出版日期:
2008-12-25

文章信息/Info

Title:
Safety and efficacy of intracoronary tirofiban injection in patients with STEMI before primary PCI
作者:
王智; 唐强; 唐群中; 陈学珠
北京大学首钢医院心内科，北京 100041
Author(s):
WANG Zhi;  TANG Qiang;  TANG Qunzhong;  CHEN Xuezhu
Department of Cardiology, Shougang Hospital of Peking University, Beijing 100041, China
关键词:
心肌梗死; 急性; ST段抬高型; 急诊经皮冠状动脉介入治疗; 梗死相关血管内血栓; 冠脉内给药; 盐酸替罗非班
Keywords:
acute STsegment elevation myocardial infarction;  primary percutaneous coronary intervention;  infarctrelated artery thrombolysis;  intracoronary;  tirofiban
分类号:
R541.4
DOI:
-
文献标识码:
A
摘要:
目的 评价冠脉内注射血小板膜糖蛋白(GP)Ⅱb/Ⅲa受体拮抗剂盐酸替罗非班在急性ST段抬高型心肌梗死(STEMI)急诊经皮冠状动脉介入(PCI)治疗中的安全性及有效性。方法 我院急性STEMI冠脉造影（CAG）显示梗死相关血管(IRA)有血栓征象的患者67例，分成试药组（PCI前冠脉内注射盐酸替罗非班＋PCI,n=35）与对照组（直接PCI,n=32），对比2组患者PCI术中IRA远端TIMI血流，术后左室射血分数（LVEF），住院期间的主要不良心血管事件（MACE）及出血情况。结果 试药组术中无再流及再灌注心律失常的发生率明显低于对照组（3％ vs 19％；3％ vs 16％，P<0.05）;试药组术后LVEF明显高于对照组［（57±5）％ vs (51±10)％，P<0.05］；住院期间MACE发生率试药组低于对照组(3％ vs 9％)，两组均未发生严重出血并发症。结论 急诊PCI前冠脉内缓慢注射盐酸替罗非班对急性STEMI患者行急诊PCI安全有效。
Abstract:
AIM To evaluate the safety and efficacy of GPⅡb/Ⅲa receptor antagonists intracoronary tirofiban injection in patients with acute STsegment elevation myocardial infarction (STEMI) before primary PCI. METHODS Sixtyseven acute STEMI patients (48 men and 19 women, aged 57±8 years old) with TAR thrombolysis during CAG from the past 2 years were divided into two groups: intracoronary tirofiban injection＋PCI group (n=35) and primary PCI group (n=32). TIMI flow during operation, post operation cardiac function (left ventricular ejection fraction), major adverse cardiovascular events (MACE) rates and bleeding state in hospital were compared between the two groups. RESULTS The rates of noreflow and arrhyehmia in intracoronary tirofiban injection＋PCI group were lower than that in primary PCI group（3％ vs 19％, 3% vs 16%, P<0.05） and so was the major adverse cardiovascular events (MACE) rates (3% vs 9％). Post operation cardiac function (LVEF) of intracoronary tirofiban injection＋PCI group was better than that in primary PCI group［（57±5）％ vs (51±10)％, P<0.05］ and no difference was found in severe hemorrhage between the two groups. CONCLUSION Intracoronary tirofiban injection before primary PCI in patients with STMEI is safe and effective.

参考文献/References

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［2］ Ito H, Okamura A, Iwakura K, et al. Myocardial perfusion patterns related to thromholysis in myocardial infarction perfusion grade after coronary angioplasty in patients with acute anterior wall myocardial infarction［J］. Circulation, 1996, 93(11):1933-1999.

［3］ Michaels AD, Gibson CM, Barron HV. Microvascular dysfunction in acute myocardial infarction: focus on the role of platelet and in flammatory mediators in the noreflow phenomenon［J］. Am J Cardiol, 2000, 85(54):50B-60B.

［4］ The RESTORE Investigators. Effects of platelet glycoprotein IIb/IIIa blockade with tirofiban on adverse cardiac events in patients with unstable angina or acute myocardial infarction underging coronary angioplasty［J］. Circulation, 1997, 96(5):1445-1453.

［5］ Montalescot G, Borentain M, Payot L, et al. Early vs late administration of glycoprotein IIb/IIIa inhibition in primary percutaneous coronary intervention of acute STsegment elevation myocardial infarction :A metaanalysis［J］. JAMA, 2004, 292(3):362-366.

备注/Memo

备注/Memo:
收稿日期：2007-12-29. 作者简介：王智，副主任医师Email：docwz6328@sina.com
更新日期/Last Update: 2009-03-24