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目的:分析急性ST段抬高心肌梗死患者急诊直接经皮冠状动脉介入治疗(PCI)联合应用血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂替罗非班时出血并发症的发生情况,探讨发生心肌梗死溶栓治疗临床试验(TIMI)出血事件的相关影响因素。方法:2005年4月至2006年3月,150例急性ST段抬高心肌梗死患者行直接PCI时应用替罗非班,平均年龄57.8±9.6(35～78)岁,男性116例。分析出血并发症发生情况,根据住院期间出血事件是否达到TIMI出血标准将所有患者分为TIMI出血组(n=10)和非TIMI出血组(n=140),分析两组的相关临床和介入治疗情况,以及出血事件对近期临床预后的影响,探讨应用替罗非班发生TIMI出血事件的相关影响因素。结果:在TIMI出血组中,达到轻、重度出血标准的患者分别占总病例的4.7%和2.0%。住院期间随访发现,发生TIMI轻重度出血的患者住院期间死亡/再梗联合事件发生率明显高于非TIMI出血组(分别为40%和3.6%,P<0.01),住院时间延长(P<0.01)。单因素分析显示,发生TIMI出血事件的患者中,女性比率,补救性应用替罗非班比率和术后即刻的活化部分凝血酶原时间较高(P<0.05)。Logistic多因素回归分析提示术后即刻的活化部分凝血酶原时间是急诊PCI治疗应用替罗非班发生TIMI出血事件的独立预测指标(P=0.013,OR=1.458)。结论:急性ST段抬高心肌梗死急诊介入治疗时,联合应用替罗非班存在一定的出血发生率,发生TIMI轻重度出血的患者近期预后不良。较高的活化部分凝血酶原时间是应用替罗非班发生TIMI出血事件的独立危险因素。
OBJECTIVE: To analyze the incidence of bleeding complications after acute percutaneous coronary intervention (PCI) combined with platelet glycoprotein Ⅱb / Ⅲa receptor antagonist tirofiban in patients with acute ST-segment elevation myocardial infarction (AMI) and to explore whether myocardial infarction Related Factors of Thrombolytic Therapy Clinical Trial (TIMI) Bleeding Events. METHODS: From April 2005 to March 2006, 150 patients with acute ST-segment elevation myocardial infarction received tirofiban for direct PCI, with an average age of 57.8 ± 9.6 (range, 35 to 78) years and 116 males. All patients were divided into TIMI hemorrhage group (n = 10) and non-TIMI hemorrhage group (n = 140) according to whether hemorrhagic event reached the standard of TIMI bleeding during hospitalization. The clinical and interventional treatment And the impact of bleeding events on the clinical prognosis in recent years, and to explore the related factors of TIMI hemorrhage in patients with tirofiban. Results: In the TIMI hemorrhage group, the patients who met the standard of light and severe bleeding accounted for 4.7% and 2.0% of the total cases, respectively. During follow-up during hospitalization, the incidence of death / re-infarction during hospitalization was significantly higher in patients with TIMI severe bleeding than in non-TIMI patients (40% vs 3.6%, P <0.01, P <0.01) ). Univariate analysis showed that the proportion of women, the rate of tirofiban for rescue use, and the percentage of activated partial prothrombin time immediately after surgery were higher in patients with TIMI bleeding (P <0.05). Logistic multivariate regression analysis showed that the immediate postoperative partial prothrombin time was an independent predictor of TIMI bleeding in emergency PCI (P = 0.013, OR = 1.458). Conclusions: Tirofiban combined with acute ST-segment elevation myocardial infarction has a certain incidence of bleeding, and the patients with TIMI severe and severe bleeding have poor prognosis. The higher activated partial prothrombin time was an independent risk factor for the TIMI bleeding event with tirofiban.