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目的研究对行急诊PCI治疗的急性ST段抬高心肌梗死患者应用血小板GPⅡb/Ⅲa受体拮抗剂替罗非班对术后梗死相关血管血流、心肌灌注、心功能和近期预后的影响。方法 2008年6月～2011年5月共入选78例急性前壁心肌梗死患者,随机将患者分为两组。治疗组(40例)在术后1h应用替罗非班[10μg/kg静脉推注后,以0.15μg/(kg.min)持续48h],对照组(38例)不应用替罗非班。比较两组的基线临床状况,住院期间出血事件,出院后30d和6个月的主要不良心血管事件(MACE,包括死亡、再次心肌梗死和再次靶病变血管重建)发生率及左心室射血分数。结果两组的基线临床情况差异无统计学意义;与对照组比较,治疗组出院后30d的MACE发生率显著降低(5.0%vs18.4%,P<0.05),其中再次心肌梗死发生率的降低差异具有统计学意义(2.5%vs10.5%,P<0.05)。治疗组6个月MACE发生率和再次心肌梗死发生率显著降低(分别为10.0%vs23.7%,P<0.05;2.5%vs10.5%,P<0.05),治疗组出院后30d,6个月的左心室射血分数均显著高于对照组[分别为(51±6)%vs(46±8)%,P<0.05;(57±7)%vs(50±9)%,P<0.05]。两组的出血和血小板减少症发生率差异无统计学意义。结论替罗非班可以显著降低直接经皮冠状动脉介入治疗后的急性心肌梗死患者的30d和6个月MACE发生率,改善其30d和6个月的心功能不增加出血事件。
Objective To investigate the effect of Tirofiban on platelet-derived vascular perfusion, myocardial perfusion, cardiac function and short-term prognosis in patients with acute ST-segment elevation myocardial infarction who underwent emergency PCI. Methods From June 2008 to May 2011, 78 patients with acute anterior myocardial infarction were randomly divided into two groups. Tirofiban [0.15 μg / (kg · min) for 48 h] was given to the treatment group (n = 40) at 1 h after the procedure. Tirofiban was not used in the control group (n = 38). The incidences of major adverse cardiac events (MACE, including revascularization of death, reoccurrence of myocardial infarction, and re-target lesions) and left ventricular ejection fraction were compared between the two groups at baseline, bleeding during hospitalization, and 30 and 6 months after discharge . Results Compared with the control group, the incidence of MACE at 30 days after discharge in the treatment group was significantly lower (5.0% vs 18.4%, P <0.05), and the incidence of recurrent myocardial infarction was also decreased The difference was statistically significant (2.5% vs10.5%, P <0.05). After 6 months, the incidence of MACE and re-MI in the treatment group were significantly decreased (10.0% vs23.7%, P <0.05; 2.5% vs10.5%, P <0.05) The monthly left ventricular ejection fraction was significantly higher than that of the control group [(51 ± 6)% vs (46 ± 8)%, P <0.05; (57 ± 7)% vs (50 ± 9)%, P < 0.05]. There was no significant difference in the incidence of hemorrhage and thrombocytopenia between the two groups. Conclusion Tirofiban can significantly reduce the 30-day and 6-month MACE incidence of patients with acute myocardial infarction after percutaneous coronary intervention and improve their 30-day and 6-month cardiac function without increasing bleeding.