冠状动脉内应用替罗非班在老年急性心肌梗死急诊PCI中的疗效与安全性

王文广; 卜军; 何奔

doi:10.13201/j.issn.1001-1439.2014.04.015

冠状动脉内应用替罗非班在老年急性心肌梗死急诊PCI中的疗效与安全性

- 1 河北省秦皇岛市第一医院心脏重症监护室(河北秦皇岛, 066000);
- 2上海交通大学医学院附属仁济医院心内科
基金项目:
上海市科委国际合作项目 (No:12410708300)

详细信息

通讯作者: 何奔, E-mail:heben1026@hotmail.com

中图分类号: R541.4

收稿日期: 2013-04-02

修回日期: 2013-07-07

Efficacy and safety of intracoronary tirofiban during primary percutaneous coronary intervention in aged patients with acute ST-segment elevation myocardial infarction

- 1 Department of CCU, Qinhuangdao First Hospital, Qinhuangdao, Hebei, 066000, China;
- 2 Department of Cardiology, Shanghai Renji Hospital, School of Medicine, Shanghai Jiaotong University

More Information

Corresponding author: HE Ben, E-mail: heben1026@hotmail.com

Received Date: 02 April 2013

Revised Date: 07 July 2013

摘要

摘要: 目的:探讨冠状动脉 (冠脉) 内应用Ⅱb/Ⅲa受体拮抗剂替罗非班在急性ST段抬高型心肌梗死 (STEMI) 老年患者 (≥ 75岁) 急诊经皮冠脉介入 (PPCI) 治疗中的疗效及安全性。方法:入选因STEMI行PPCI的老年患者104例, 随机分为替罗非班组及对照组。主要临床终点是PPCI术后心肌微循环灌注水平, 次要临床终点是:①住院期间不良事件 (死亡、再梗死、靶血管重建和脑卒中);②B型脑利钠肽 (BNP), 左室射血分数 (LVEF) 及左室舒张末期内径 (LVDd);③出血及消化道不良症状。结果:替罗非班组术后心肌微循环灌注水平明显高于对照组 (MBG 2~3级:79.63%:58.00%, P<0.05);替罗非班组与对照组入院时BNP无明显差异, 入院1周时替罗非班组BNP低于对照组[(117.5±23.50) ng/ml:(245.1±27.11) ng/ml, P<0.01], 替罗非班组LVEF值高于对照组[(57.13±7.37)%:(51.19±5.68)%, P<0.05], 两组LVDd差异无统计学意义;两组住院期间不良事件发生率、严重及中度出血发生率及消化道不良症状发生率差异无统计学意义;替罗非班组轻度出血发生率高于对照组 (16.67%:4.00%, P<0.05)。结论:老年STEMI患者冠脉内应用替罗非班可提高心肌微循环灌注水平, 不增加严重出血事件, 但应注意观察轻度出血事件。
- 急性心肌梗死 /
- 血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂 /
- 经皮冠状动脉介入治疗
Abstract: Objective:To investigate the efficacy and safety of intracoronary tirofiban administration during primary percutaneous coronary intervention (PPCI) in aged (≥ 75 years) patients with ST-segment elevation myocardial infarction (STEMI).Method:A total of 104 aged STEMI patients treated with PPCI were randomly divided into tirofiban group and control group.The primary endpoint was myocardial tissue-level perfusion assessed by myocardial blush grade (MBG).The secondary endpoint was:① major adverse cardiac events (MACE) including sudden death, reinfarction, target vessel revascularization and stroke during hospitalization;②B-type natriuretic peptide (BNP), left ventricular ejection fraction (LVEF) and left ventricular end diastolic dimension (LVDd); ④bleeding complications during hospitalization.Result:Tirofiban group had a higher myocardial tissue perfusion than control group (MBG 2-3:79.63% vs 58.00%, P<0.05).In tirofiban group, BNP level was lower than that in control group[(117.5±23.50) ng/ml vs (245.1±27.11) ng/ml, P<0.01] and LVEF was higher[(57.13 ±7.37)% vs (51.19±5.68)%, P<0.05]1 week after admission.There was no significant difference in BNP the admission day and LVDd after a week.The incidences of MACE and major or moderate bleeding event were similar between the two groups.The incidence of mild bleeding in tirofiban group was higher than that in control group (16.67% vs 4.00%, P<0.05).The incidences of gastrointestinal adverse symptoms were similar between the two groups.Conclusion:Intracoronary administration of tirofiban in aged STEMI patients undergoing PPCI could improve myocardial tissue perfusion without increasing major bleeding event.However, careful attention should be paid to the possible mild bleeding.
- acute myocardial infarction /
- glycoproteinⅡb/Ⅲa inhibitors /
- primary percutaneous coronary in-tervention

HTML全文

参考文献(14)

[1]	GOLDBERG R J, MCCORMICK D, GURWITZ J H, et al.Age-related trends in short-and long-term survival after acute myocardial infarction:a 20-year populationbased perspective (1975-1995)[J].Am J Cardiol, 1998, 82:1311-1317.
[2]	PU J, SHAN P, DING S, et al.Gender differences in epicardial and tissue-level reperfusion in patients undergoing primary angioplasty for acute myocardial infarction[J].Atherosclerosis, 2011, 215:203-208.
[3]	PU J, SHAN P R, DING S, et al.Factors affecting thrombolysis in myocardial infarction myocardial perfusion frame count:insights of myocardial tissue-level reperfusion from a novel index for assessing myocardial perfusion[J].Chin Med J (Engl), 2011, 124:873-878.
[4]	PU J, DING S, SHAN P, et al.Comparison of epicardial and myocardial perfusions after primary coronary angioplasty for ST-elevation myocardial infarc-tion in patients under and over 75years of age[J].Aging Clin Exp Res, 2010, 22:295-302.
[5]	NGUYEN C M, HARRINGTON R A.Glycoprotein IIb/IIIa receptor antagonists:a comparative review of their use in percutaneous coronary intervention[J].Am J Cardiovasc Drugs, 2003, 3:423-436.
[6]	HEESTERMANS T, VAN'T HOF A W, TEN BERG J M, et al.The golden hour of prehospital reperfusion with triple antiplatelet therapy:A sub-analysis from the Ongoing Tirofiban in Myocardial Evaluation 2 (On-TIME 2) trial early initiation of triple antiplatelet therapy[J].Am Heart J, 2010, 160:1079-1084.
[7]	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.
[8]	EVOLA S, CUTTITTA F, EVOLA G, et al.Early detection of coronary artery flow and myocardial perfusion impairment in hypertensive patients evidenced by myocardial blush grade (MBG) and thrombolysis in myocardial infarction (TIMI) frame count (TFC)[J].Intern Med, 2012, 51:1653-1660.
[9]	The GUSTO Investigators.An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction[J].N Engl J Med, 1993, 329:673-682.
[10]	LIMBRUNO U, MICHELI A.Mechanical prevention of distal embolization during primary angioplasty:safety, feasibility, and impact on myocardial reperfusion[J].Circulation, 2003, 108:17l-176.
[11]	WILKERSON W R, SANE D C.Aging and thrombosis[J].Semin Thromb Hemost, 2002, 28:555-568.
[12]	VALGIMIGLI M, BIONDI-ZOCCAI G, TEBALDI M, et al.Tirofiban as adjunctive therapy for acute coronary syndromes and percutaneous coronary intervention:a meta-analysis of randomized trials[J].Eur Heart J, 2010, 31:35-49.
[13]	SHANMUGASUNDARAM M.Percutaneous coronary intervention in elderly patients:is it beneficial?[J].TeX Heart Inst J, 2011, 38:398-403.
[14]	KLOER R A, DAI W.Glycoprotein IIb/IIIa inhibitors and noreflow[J].J Am Coll Cardiol, 2004, 43:284-286.