急诊冠状动脉支架术联合国产替罗非班治疗急性ST段抬高性心肌梗死的临床疗效和安全性  

Clinical outcomes and safety of primary percutaneous coronary intervention combined with tirofiban therapy in patients with acute ST-segment elevation myocardial infarction

作　　者：沈杰[1] 张奇[1] 张瑞岩[1] 张建盛[1] 胡健[1] 杨震坤[1] 郑爱芳[1] 张宪[1] 沈卫峰[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院心内科,200025

出　　处：《中华心血管病杂志》2007年第11期1005-1009,共5页Chinese Journal of Cardiology

基　　金：上海市科学技术委员会资助项目(05DZ19503)

摘　　要：目的前瞻性评价急性 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)联合应用国产替罗非班治疗的临床疗效及安全性。方法入选连续160例接受急诊 PCI 治疗的急性 STEMI 患者,随机分为替罗非班组(80例)和对照组(80例)。比较两组基础临床情况、介入治疗结果、术后即刻疗效、术后30天和180天主要心脏不良事件(MACE,包括死亡、再梗死、再次靶血管重建)发生率及左室射血分数(LVEF)。结果两组基础临床情况、介入治疗结果差异均无统计学意义。与对照组相比,替罗非班组术后即刻心肌梗死溶栓试验(TIMI)3级复流血流差异无统计学意义(95.0%比87.5%,P>0.05),但即刻心肌组织灌注(TMP)3级(75.0%比56.3%,P<0.05)、校正 TIMI 帧数[(23.56±5.19)帧比(31.05±6.92)帧,P<0.01)]、ST 段抬高总和回落[(6.51±3.56)mm 比(4.53±2.47)mm,P<0.01]、肌酸激酶同工酶(CK-MB)峰值[(225.02±105.81)μg/L比(269.20±110.88)μg/L,P<0.05)、肌钙蛋白 I(TnI)峰值[(45.25±33.00)μg/L 比(56.46±29.48)μg/L,P<0.05]及平均住院天数[(11.38±4.63)天比(14.68±6.90)天,P<0.01]均显著优于对照组。替罗非班组术后 MACE 发生率30天(5.0%比16.3%,P<0.05)和180天(7.5%比18.8%,P<0.05)明显降低,LVEF(术后30天:53%±7%比49%±9%,P<0.01;术后180天:59%±8%比53%±9%,P<0.01)显著提高。多因素 logistic 回归分析表明,年龄>65岁[比值比(OR)=3.42,P<0.01]、替罗非班治疗(OR=0.56,P<0.05)、住院期 LVEF<0.5(OR=2.56,P<0.01)是术后180天 MACE 发生率的主要决定因素。替罗非班组术后出血并发症发生率高于对照组(16.3%和7.5%),但差异无统计学意义(P>0.05)。结论急诊冠状动脉支架术联合应用国产替罗非班治疗STEMI 能显著提高相关梗死区域再灌注水平,明显改善术后即刻、术后30天及180天临床预后和左心室收缩功能。Objective This prospective study was conducted to investigate the clinical outcomes and safety of primary percutaneous coronary intervention （ PCI ） combined with tirofiban therapy in patients with acute ST-segment elevation myocardial infarction （STEMI）. Methods One hundred and sixty consecutive patients with acute STEMI were randomly allocated to either primary PCI combined with tirofiban therapy （Tirofiban group, n = 80 ） or primary PCI treatment alone （Control group, n = 80 ）. Baseline characteristics, PCI features and clinical outcomes during hospitalization were compared between the two groups. Left ventricular ejection fraction （LVEF） and major adverse cardiac events （MACE, including death, re-infarction and target vessel revascularization） at 30 and 180 days after discharge were also compared. Results The baseline clinical characteristics were comparable between the two groups. Despite similar TIMI grade 3 flow （ 95% vs. 87.5% , P 〉 0. 05 ） between the tirofiban and control groups immediately after the procedure, TMP grade 3 （75% vs. 56. 3%, P 〈 0. 05） , corrected TIMI frame count （cTFC, 23.56±5. 19 vs. 31.05±6. 92,P 〈0. 01 ）, resolution of sum of ST-segment elevation （6. 51 ± 3.56 mm vs. 4. 53 ± 2.47 mm, P 〈 0. 01 ）, peak value of CK-MB （225.02 ± 105.81 μg/L vs. 269. 20 ± 110. 88 μg/L,P 〈 0. 05 ） and TnI （ 45.25 ± 33.00 μg/L vs. 56.46 ± 29.48 μg/L, P 〈 0.05 ） in tirofiban group were significantly superior to the control group related to a shorter hospital stay （ 11.38 ± 4. 63 days vs. 14. 68±6. 90 days,P 〈 0. 01 ）. Compared to control group, the MACE rates at 30 days （5. 0% vs. 16. 3% ,P 〈0. 05）and 180 days（7.5% vs. 18.8% ,P 〈 0. 05） were also significantly reduced and LVEF was significantly improved（30 days ：53% ±7% vs. 49% ±9%,P〈0.01; 180 days：59% ±8% vs. 53% ±9% ,P 〈0. 01 ） in tirofiban group. Multivariate logistic analysis revealed that age 〉 65 years（ OR = 3.42 ,P 〈0.01 ）, tirofiban th

关 键 词：冠状动脉疾病 心肌梗塞 血管成形术 经腔 经皮冠状动脉 支架 替罗非班 预后 

分 类 号：R542.22[医药卫生—心血管疾病]