摘要
目的探讨未行早期介入治疗的急性非sT段抬高心肌梗死（NSTEMI）患者替罗非班应用的有效性和安全性。方法多中心选择未行介入治疗的NSTEMI患者151例，随机分为替罗非班组（76例）与对照组（75例），择期行冠状动脉造影，必要时进行经皮经冠状动脉介入治疗（PCI）干预，观察两组疗效的差异。结果替罗非班并未增加PCI术前心肌梗死溶栓治疗（TIMI）分级2级以上比率（78．9％与69．3％，P=0．10），但是替罗非班组PCI术后TIMI血流2级以上比率显著高于对照组（100．0％比96．0％，P=0．04），PCI后心肌灌注不良的发生率替罗非班组低于对照组（19．7％比34．7％，P=0．04）。替罗非班组与对照组30d内发生主要不良心脏事件（MACE）分别为0例与4例（0．0％比5．3％，P=0．05）。两组30d内各种出血事件差异均无统计学意义。结论替罗非班虽未增加出血并发症，但亦不能改善非介入治疗的NSTEMI患者靶血管的开通率，只可能进一步提高PCI后的TIMI血流和可改善PCI后的心肌灌注状态，并有降低30d内MACE发生的趋势。
Objective To study the efficacy and safety of tirofiban in patients with acute non-ST segment elevation myocardial infarction （NSTEMI） without early reperfusion intervention. Methods A total of 151 NSTEMI patients without early reperfusion intervention were enrolled in the study and randomized to the tirofiban group （tt = 76） and the control group （n = 75 ）. Coronary angiography was performed at day 3 and day 7, while percutaneous coronary intervention （PCI） was performed when necessary. Parameters including thrombolysis in myocardial infarction （TIMI） flow, bleeding complications and clinic events within 30 days were compared between the two groups. Results Before PCI, no increase in the percentage of patient with TIMI flow better than TIMI-2 was observed by the treatment of tirofiban （69. 3% vs 78.9%, P =0. 10）. While after PCI, significant increase in the percentage of patient with TIMI flow better than TIMI-2 was manifested in the tirofiban group （ 96. 0% vs 100. 0%, P = 0. 04 ）. Tirofiban treatment also significantly decreased the rate of poor myocardial perfusion after PCI （ 19. 7% vs 34. 7%, P = 0. 04 ）. There were 0 and 4 major adverse eardiovaseulay events （MACE） within 30 days observed in the firofiban group and the control group （0. 0% vs 5.3% , P =0.05）. No difference between the two groups was found in the bleeding complications within 30 days including the mild hemorrhage （ 5 vs 4 cases, P = 0. 75 ）, severe hemorrhage （2 vs 1 cases, P = 0.56） or severe thromboeytopenia （2 vs 0 cases, P = 0.49）. Conclusions Tirofiban treatment does not increase the bleeding complications in NSTEMI patients without early PCI. Tirofiban can improve the TIMI flow and the myocardial perfusion after PCI with less MACE within 30 days.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2014年第3期193-197,共5页
Chinese Journal of Internal Medicine
关键词
心肌梗死
血小板聚集抑制剂
血管成形术
经腔
经皮冠状动脉
Myocardial infarction
Platelet aggregation inhibitors
Angioplasty, transluminal,percutaneous coronary
