瑞替普酶溶栓成功后早期冠状动脉介入治疗的安全性及有效性研究  

Safety and feasibility of early coronary interventional treatment after successful thrombolysis with reteplase

作　　者：耿巍[1] 傅向华[2] 田祥[1] 刘轶园 刘倩梅 孟海云[1] 刘欣[1] 李亭亭[1] 李良[1] 王培军[1] 

机构地区：[1]河北省保定市第一中心医院心内科,保定071000 [2]河北医科大学第二医院心内科

出　　处：《中国介入心脏病学杂志》2013年第5期310-314,共5页Chinese Journal of Interventional Cardiology

摘　　要：目的本研究旨在评价瑞替普酶溶栓成功后12 h内经桡动脉行经皮冠状动脉介入治疗(PCI)对急性ST段抬高心肌梗死(STEMI)患者的安全性及可行性。方法 224例急性STEMI患者,应用瑞替普酶溶栓治疗,溶栓成功后随机分为早期介入治疗(E-PCI)组和择期介入治疗(S-PCI)组(各112例)。E-PCI组于分组后12 h内经桡动脉行PCI,S-PCI组于分组后1周经桡动脉行PCI。主要终点为住院期间复合终点事件的发生率,包括死亡、再发心肌梗死、再发心绞痛与充血性心力衰竭;次要终点为12个月随访期内的死亡、再发心肌梗死、再发心绞痛与再次血运重建的发生率。结果两组患者的基线资料差异无统计学意义。E-PCI组住院时间较S-PCI组明显缩短(P<0.001)。E-PCI组与S-PCI组术后冠状动脉TIMI血流分布、无复流的发生率、梗死相关血管分布及对比剂用量方面差异无统计学意义,但E-PCI组患者应用替罗非班的比例明显偏高(30.3%比10.7%,P=0.001)。E-PCI组主要终点事件发生率明显降低(4.5%比14.3%,P=0.022),两组住院期间再发心肌梗死、充血性心力衰竭及死亡等指标差异无统计学意义,在12个月随访期内累计的死亡、再发心肌梗死及再发心绞痛差异无统计学意义。两组根据TIMI分级标准记录到的出血并发症的发生率差异无统计学意义。结论急性STEMI患者,如不能及时行直接PCI,则应用瑞替普酶溶栓后早期经桡动脉行PCI可明显降低患者住院期间再发心绞痛的发生率。Objective The goal of this study was to evaluate the safety and feasibility of early angioplasty within 12 hours and selective angioplasty 1 week later after successful thrombolysis with reteplase in acute ST segment elevation myocardial infarction（STEMI）. Methods A total of 224 patients with acute STEMI received thrombolysis with reteplase were randomly assigned to early PCI （E-PCI） group or selective PCI （S-PCI） group. Patients assigned to the E-PCI group received interventional procedure within 12 hours after randomization, and patients assigned to the S-PCI group received interventional procedure 1 week later after randomization. The primary end point was a combined end points consisting of death, reinfaretion, recurrent ischemia, congestive heart failure during hospitalization. The secondary end points included death, reinfarction, recurrent ischemia and repeat PCI during 12 months follow up. Results The baseline clinical characteristics were well balanced between the two groups. The primary end point rate was significantly lower in the E-PC1 group compared with the S-PCI group （4. 5% vs. 14. 3% , P = 0. 022）. Fewer episodes of recurrent ischemia were seen in the E-PCI group compared with the S-PCI group during hospital stay （0. 0% vs. 6. 3% , P =0. 021 ）. There was no significant difference in bleeding complication （ 12. 5% vs. 8.9% , P = 0. 517 ）. The secondary end points were no significant differences during 12 months follow up. Conclusions Patients presenting with a ST-segment elevation myocardial infarction who could not undergo timely primary PCI, thrombolysis and followed by PCI within 12 hours was a preferred reperfusion strategy and associated with a significant reduction of the recurrent angina during hospitalization.

关 键 词：瑞替普酶 经皮冠状动脉介入治疗 支架 心肌梗死 

分 类 号：R542.2[医药卫生—心血管疾病]