急性ST段抬高型心肌梗死患者经抽吸导管冠脉内局部推注替罗非班的疗效研究

摘要

目的 比较急性心肌梗死患者在行急诊经皮冠状动脉介入治疗(PCI)时,通过抽吸导管冠状动脉病变处给予替罗非班与经指引导管冠状动脉内给予替罗非班的疗效差别.方法 选取2013年1月~2016年1月于江苏省丹阳市人民医院行急诊PCI的急性ST段抬高型心肌梗死的患者共81例,其中40例经抽吸导管在罪犯血管堵塞处局部缓慢推注替罗非班,41例经指引导管冠状动脉内缓慢推注替罗非班.主要终点为各种原因的30 d死亡;次要终点包括PCI术后即刻心肌梗死溶栓治疗(TIMI)血流、心肌呈色分级(MBG)、住院期间再次心肌梗死、靶血管重建、不稳定型心绞痛及心力衰竭.结果 两组患者年龄、性别、心血管疾病危险因素、血压、心率比较差异无统计学意义.经抽吸导管冠状动脉内局部给药组MBG3级患者明显多于经指引导管给药组(68%vs.36%,P=0.002),非致死性心力衰竭则明显减少(12.5%vs.25.6%,P=0.0027).两组患者各种原因30 d死亡(2.5%vs.2.4%,P=0.943)、TIMI血流3级(92.5%vs.87.8%,P=0.848)、住院期间再次心肌梗死(0%vs.1.2%,P=0.764)、靶血管重建(2.5%vs.4.9%,P=0.931)及不稳定性心绞痛(15%vs.19.5%,P=0.840)的发生情况差异无统计学意义.结论直接PCI术中经抽吸导管冠状动脉内局部缓慢给药能改善心肌灌注,减少住院期间非致死性心力衰竭发生率,但是对于30 d内不良事件的发生与对照组相比无明显改善.%Objectives In patients with acute ST-segment elevation myocardial infarction (STEMI) who underwent percutaneous coronary intervention (PCI), the efficacy of tirofiban administrated through aspiration catheter and guided catheter was compared.Methods 81 patients with acute STEMI undergoing primary PCI were enrolled between January 2013 and January 2016, 40 patients were administrated tirofiban in the plug of culprit vessel through aspiration catheter, 41 patients were administrated tirofiban through guided catheter in the coronary. The primary end point is death within 30 days of various causes; secondary end points include immediate thrombolysis in myocardial infarction (TIMI) after PCI, myocardial blush grades (MBG), re-myocardial infarction during hospitalization, target vessel reconstruction (TVR), Unstable angina (UA) and heart failure (HF).Results There were no significant differences in age, sex, cardiovascular risk factors, blood pressure and heart rate between the two groups. The incidence of MBG 3 in aspiration catheter group was significant higher than that in guided catheter group (68%vs. 36%;P value = 0.002). The incidence of nonfatal heart failure in aspiration catheter group was significant lower than that in guided catheter group (12.5%vs. 25.6%;P value = 0.0027). There were no significant differences in death within 30 days (2.5%vs. 2.4%;P value = 0.943), TIMI 3 (92.5%vs. 87.8%;P value= 0.848), re-myocardial infarction during hospitalization (0%vs. 1.2%;P value = 0.764), TVR (2.5%vs. 4.9%;P value = 0.931), UA (15%vs. 19.5%;P value = 0.840).Conclusion Tirofiban administrated through aspiration catheter during PCI can improve myocardial perfusion, reduce the incidence of non-fatal heart failure during hospitalization, but cannot reduce adverse events within 30 days.