血栓抽吸加替罗非班对改善急性心肌梗死患者预后的疗效评价  

Effects of thrombus aspiration plus tirofiban on clinical outcomes in patients with ST-elevation myocardial infarction

作　　者：刘振兵[1] 赵林凤[1] 杨文霞 王乐丰[3] 

机构地区：[1]鄂尔多斯市中心医院心内科,内蒙古鄂尔多斯017000 [2]鄂尔多斯市胜区人民医院超声科 [3]首都医科大学附属北京朝阳医院心脏中心

出　　处：《临床心血管病杂志》2014年第10期843-847,共5页Journal of Clinical Cardiology

摘　　要：目的:评价血栓抽吸加替罗非班对急性ST段抬高型心肌梗死(STEMI)患者的疗效。方法:回顾性分析行直接经皮冠状动脉介入(PPCI)治疗的STMEI患者,根据是否使用血栓抽吸或替罗非班,将患者分为4组:标准PPCI组(SP组),替罗非班组(TI组),血栓抽吸组(AT组),血栓抽吸+替罗非班组(AT+TI组)。观察各组患者心肌显影分级(MBG)和心电图ST段回落(STR)情况。随访2年,统计心因性死亡、心因性死亡和非致死性心肌梗死复合终点及主要不良心血管事件。结果:心肌再灌注在AT+TI组明显改善(MBG≥2,P=0.008;STR≥70%,P=0.005);心因性死亡、心因性死亡和非致死性心肌梗死复合终点及主要心血管不良事件患者的心肌再灌注明显变差(MBG≥2,均P<0.01;STR≥70%,均P<0.01)。2年随访发现,血栓抽吸加替罗非班能明显降低STEMI患者心因性死亡(P=0.008)、心因性死亡和非致死性心肌梗死复合终点(P=0.006)及主要心血管不良事件(P=0.009)。结论:血栓抽吸+替罗非班能改善STEMI患者临床预后。Objective：To evaluate the additional benefit of tirofiban to thrombus aspiration during primary percutaneous coronary intervention（PPCI）in ST-segment elevation myocardial infarction（STEMI）.Method：A total of 871 patients with STEMI underwent PPCI were consecutively enrolled into four groups：standard PPCI group（SP group）,tirofiban infusion（TI group）,thrombus aspiration before stenting group（AT group）,and combined treatment group（AT＋TI group）.Myocardial blush grade（MBG）and ST-segment resolution（STR）were observed.All patients were followed up for 2years to assess major adverse cardiovascular events（MACEs）,including cardiac death,non-fatal reinfarction,target vessel revascularization,and stent thrombosis.Result：Myocardial reperfusion was significantly improved in AT＋TI group compared to SP group（MBG ≥2,P=0.008;STR ≥70%,P=0.005）.However,myocardial reperfusion was significantly inferior in patients with cardiac death,the combined endpoint of cardiac death or non-fatal reinfarction,and MACEs.Kaplan-Meier analysis revealed a significant decrease in cardiac death（P=0.008）,the combined endpoint of cardiac death or non-fatal reinfarction（P=0.006）,and MACEs（P=0.009）in AT＋TI group during the 2-year follow-up.Conclusion：Thrombus aspiration in combination with tirofiban infusion before stenting leads to better clinical outcomes.

关 键 词：急性心肌梗死 血栓抽吸 GPⅡb/Ⅲa受体拮抗剂 经皮冠状动脉介入 心肌再灌注 

分 类 号：R542.2[医药卫生—心血管疾病]