冠状动脉使用替罗非班对STEMI患者急诊PCI术后的影响

周恒; 刘福元; 骆峰; 黎晓兰

doi:10.13201/j.issn.1001-1439.2014.02.010

冠状动脉使用替罗非班对STEMI患者急诊PCI术后的影响

- 湖北医药学院附属襄阳医院襄阳市第一人民医院心内科(湖北襄阳, 441000)

详细信息

通讯作者: 黎晓兰,E-mail:1968715xjb@163.com

中图分类号: R542.2

收稿日期: 2013-04-10

修回日期: 2013-06-23

Effect of intracoronary tirofiban in patients with ST-elevation myocardial infarction after primary percutaneous coronary intervention

- Department of Cardiology Xiangyang No.1 People's Hospital, Xiangyang, Hubei, 441000, China

More Information

Corresponding author: LI Xiaolan, E-mail: 1968715xjb@163.com

Received Date: 10 April 2013

Revised Date: 23 June 2013

摘要

摘要: 目的:探讨冠状动脉 (冠脉) 使用替罗非班对急性ST段抬高心肌梗死 (STEMI) 患者在急诊冠脉介入治疗 (PCI) 术后TIMI血流、肌酸激酶同工酶 (CK-MB) 及肌钙蛋白 (TnT)、主要心血管不良事件 (MACE) 的影响。方法:将164例入选的行急诊PCI的STEMI患者随机分为冠脉使用替罗非班组 (冠脉组, 84例) 和静脉使用替罗非班组 (静脉组, 80例), 在急诊PCI术前及完成后测定梗死相关血管 (IRA) 的TIMI血流, 在发病12、24h采静脉血查CK-MB及TnT。观察PCI术后2h心电图ST段回落情况, 观察PCI术后3d出血事件。随访30d记录MACE。结果:与静脉组比较, 冠脉组明显改善PCI术后IRA的TIMI血流[(2.95±0.17):(2.84±0.22), P<0.05], 明显降低12、24h时的CK-MB与TnT水平 (均P<0.05), 明显增加PCI术后2h心电图ST段回落>70%的例数 (P<0.05)。两组术后出血事件及30dMACE没有显著差异。结论:对于行急诊PCI的STEMI患者, 与静脉使用替罗非班比较, 冠脉使用替罗非班可有效改善心肌灌注, 减小心肌梗死面积。
- 心肌梗死 /
- 替罗非班 /
- 介入治疗
Abstract: Objective: To explore the effect of intracoronary tirofiban on TIMI flow grade, creatine kinase MB (CK-MB), troponin T (TnT), major adverse cardiovascular events (MACE) in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).Method: All 164 patients with STEMI undergoing primary PCI were selected and randomized into intracoronary tirofiban group (n=84) and intravenous tirofiban group (n=80).TIMI flow grade on infarction related artery (IRA), CK-MB, and TnT were measured at baseline and after PCI.ST segment resolution was observed in 2hours after primary PCI.The incidence of bleeding complications was observed in 3days after primary PCI.The incidence of MACE was recorded at 30days after primary PCI.Result: Compared with intravenous tirofiban group, TIMI flow grade on IRA was significantly improved[(2.95±0.17) vs (2.84±0.22), P<0.05], the levels of CK-MB and TnT in 12 hours and 24hours after PCI were significantly decreased (all P<0.05), the incidence of ST segment resolution greater than 70%in 2hours after PCI was increased (P<0.05) in intracoronary tirofiban group.The incidence of bleeding complications and MACE at 30days after primary PCI was showed no significant difference between 2 groups.Conclusion: In patients with STEMI undergoing primary PCI, intracoronary tirofiban may improve myocardial reperfusion and decrease infarction size more effectively compared with intravenous tirofiban.
- myocardial infarction /
- tirofiban /
- primary percutaneous coronary intervention

HTML全文

参考文献(10)

[1]	KUSHNER F G, HAND M, SMITH S C J R, et al.2009focused updates:ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004guideline and 2007focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005guideline and 2007focused update) a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J].J Am Coll Cardiol, 2009, 54:2205-2241.
[2]	崔晓琼, 李彤, 王怀祯, 等.盐酸替罗非班在急性心肌梗死患者急诊冠状动脉介入治疗中的有效性和安全性评价[J].临床心血管病杂志, 2010, 26 (5):332-335.
[3]	WU T G, ZHAO Q, HUANG W G, et al.Effect of intracoronary tirofiban in patients undergoing percutaneous coronary intervention for acute coronary syndrome[J].Circ J, 2008, 72:1605-1609.
[4]	CANDEMIR B, KILICKAP M, OZCAN O U, et al.Intracoronary versus intravenous high-dose bolus plus maintenance administration of tirofiban in patients undergoing primary percutaneous coronary intervention for acute ST elevation myocardial infarction[J].J Thromb Thrombolysis, 2012, 34:65-72.
[5]	THIELE H, SCHINDLER K, FRIEDENBERGER J, et al.Intracoronary compared with intravenous bolus abciximab application in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention:the randomized Leipzig immediate percutaneous coronary intervention abciximab IV versus IC in STelevation myocardial infarction trial[J].Circulation, 2008, 118:49-57.
[6]	GU Y L, KAMPINGA M A, WIERINGA W G, et al.Intracoronary versus intravenous administration of abciximab in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention with thrombus aspiration:the comparison of intracoronary versus intravenous abciximab administration during emergency reperfusion of ST-segment elevation myocardial infarction (CICERO) trial[J].Circulation, 2010, 122:2709-2717.
[7]	HANSEN P R, IVERSEN A, ABDULLA J.Improved clinical outcomes with intracoronary compared to intravenous abciximab in patients with acute coronary syndromes undergoing percutaneous coronary intervention:a system-atic review and meta-analysis[J].J Invasive Cardiol, 2010, 22:278-282.
[8]	WOHRLE J, GREBE O C, NUSSER T, et al.Reduction of major adverse cardiac events with intracoronary compared with intravenous bolus application of abciximab in patients with acute myocardial infarction or unstable angina undergoing coronary angioplasty[J].Circulation, 2003, 107:1840-1843.
[9]	DEIBELE A J, JENNINGS L K, TCHENG J E, et al.Intracoronary eptifibatide bolus administration during percutaneous coronary revascularization for acute coronary syndromes with evaluation of platelet glycoprotein IIb/IIIa receptor occupancy and platelet function:the Intracoronary Eptifibatide (ICE) Trial[J].Circulation, 2010, 121:784-791.
[10]	SHEN W F.Direct intracoronary delivery of tirofiban during primary percutaneous coronary intervention for ST-elevation myocardial infarction[J].Chin Med J (Engl), 2012, 125:3-6.