冠状动脉内联合应用腺苷和替罗非班与单独应用替罗非班在直接冠状动脉介入治疗中的疗效比较  

Efficacy comparison of combined intracoronary administration of high-dose adenosine and tirofiban versus intracoronary tirofiban during primary percutaneous coronary intervention in patients with acute myocardial infarction0推荐Efficacy comparison of combined intracoronary administration of high-dose adenosine and tirofiban versus intracoronary tirofiban during primary percutaneous coronary intervention in patients with acute myocardial infarction0推荐

作　　者：佟子川[1] 李强[1] 陈明[1] 缪国斌[1] 魏妤[1] 李飞鸥[1] 赵华[1] 张建军[1] 

机构地区：[1]首都医科大学附属北京朝阳医院心脏中心,100043

出　　处：《中华心血管病杂志》2013年第10期839-844,共6页Chinese Journal of Cardiology

基　　金：吴阶平基金会资助项目（320675007122）

摘　　要：目的 评价急性ST段抬高心肌梗死（STEMI）直接经皮冠状动脉介入治疗（PCI）中冠状动脉内联合应用高剂量腺苷与替罗非班的疗效和安全性.方法 本研究为前瞻性、单中心、随机对照研究,连续入选258例接受直接PCI的STEMI患者,用随机数字表分为腺苷组（130例）和对照组（128例）.所有患者术中均行血栓抽吸,并经抽吸导管冠状动脉内给予替罗非班（10μg/kg）推注,腺苷组于血栓抽吸后及支架置入后经抽吸导管冠状动脉内给予腺苷2 mg推注,共2次,对照组给予生理盐水推注.首要终点为术后心肌Blush分级（MBG）,次要终点包括术后心肌梗死溶栓试验（TIMI）血流分级与校正的TIMI帧数（CTFC）、总ST段抬高回落及12个月主要不良心脏事件（MACE）.结果 两组术后TIMI血流分级差异无统计学意义,腺苷组CTFC明显优于对照组[（21.6±6.5）帧比（25.1±7.8）帧,P=0.001].腺苷组术后MBG 3级的患者多于对照组[45.1％ （55/122）比32.0％（39/122）,P=0.035].腺苷组有较多ST段完全回落的趋势[53.6％ （67/125）比41.9％ （52/124）,P=0.065].腺苷组与对照组术后30 d[12.3％ （16/130）比17.2％ （22/128）,P=0.295]与12个月[12.3％ （16/130）比18.0％ （23/128）,P=0.227] MACE发生差异无统计学意义.结论 在选择性STEMI患者,联合冠状动脉内应用替罗非班与高剂量腺苷可能进一步改善直接PCI术后心肌灌注,但对临床事件的影响有待进一步研究.Objective To compare the efficacy of intracoronary administration of combined highdose adenosine and tirofiban versus intracoronary tirofiban during primary percutaneous coronary intervention （PCI） in patients with acute myocardial infarction.Methods Consecutive 258 patients with acute STsegment elevation myocardial infarction （STEMI） underwent primary PCI,treated with thrombus aspiration and then intracoronary tirofiban,were randomly divided into adenosine group （n =130） and control group （n =128）.Adenosine group received 2 times intracoronary adenosine （2 mg） after thrombus aspiration and after stenting of the infarct-related artery through the aspiration catheter.Control group received placebo.The primary end point was myocardial blush grade （MBG） after PCI.Secondary end points were thrombolysis in myocardial infarction （TIMI） flow grade and corrected TIMI frame count （CTFC） after PCI,ST-segment elevation resolution （STR）,and major adverse cardiac events （MACE） at 30 days and 12 months.Results TIMI flow grade post PCI did not differ between the 2 groups,while CTFC favored the adenosine-treated patients [（21.6 ± 6.5） frames] compared with the placebo-treated patients [（25.1 ±7.8） frames,P =0.001].MBG 3 was more frequently observed in the adenosine compared to the control group [45.1% （55/122） vs.32.0% （39/122）,P =0.035].Patients in the adenosine group had a trend of higher rate of compete STR after the procedure compared patients in the control group [53.6% （67/125）vs.41.9% （52/124）,P =0.065].The incidence of MACE was comparable between patients randomized to adenosine and placebo at 30 days [12.3% （16/130） vs.17.2% （22/128）,P =0.295] and at 12 months [12.3% （16/130） vs.18.0% （23/128）,P =0.227].Conclusion Intracoronary administration of highdose adenosine combined with tirofiban provides further improvement on myocardial perfusion after primary PCI but does not affect the clinical outcomes in patients with STEMI.

关 键 词：心肌梗死 血管成形术 经腔 经皮冠状动脉 腺苷 心肌再灌注 

分 类 号：R541.4[医药卫生—心血管疾病]