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目的评估替罗非班对急性ST段抬高心肌梗死(STEMI)患者梗死相关动脉自发再通、经皮冠状动脉介入治疗(PCI)后心肌灌注及住院期预后的影响。方法连续入选316例急性STEMI患者,随机决定急诊室给予替罗非班(156例)与否(160例)。根据急诊冠脉造影结果分为TMP 0～1级组(218例)和TMP 2～3级组(98例)。所有TMP 0～1级患者均行紧急PCI,据替罗非班的应用情况分为替罗非班亚组(91例)与常规治疗亚组(127例)。分析替罗非班与梗死相关动脉自发再通、PCI术后心肌灌注、住院期主要心脏不良事件(MACE)的关系。结果 TMP 2～3级组甘油三酯、白细胞升高显著低于TMP 0～1级组(P<0.05),且替罗非班的应用比例显著高于TMP 0～1级组(P<0.01)。亚组分析表明,替罗非班组PCI术后即刻校正的TIMI桢数、住院时间、TMP 0～2级及住院期MACE发生率均降低(P<0.05),左室射血分数增高(P<0.05);高龄、替罗非班治疗、左室射血分数降低、术后TMP0～2级与住院期MACE发生率相关(P<0.05)。结论早期应用替罗非班可增加急性STEMI患者梗死相关动脉自发再通率,改善急诊PCI术后梗死区域心肌再灌注与住院期临床预后。
Objective To evaluate the effect of tirofiban on myocardial infarction-related artery recanalization and percutaneous coronary intervention (PCI) in patients with acute ST-elevation myocardial infarction (STEMI) after myocardial perfusion and in-hospital prognosis. Methods A total of 316 patients with acute STEMI were enrolled and randomized to receive tirofiban in the emergency department (n = 156) or not (n = 160). According to the results of emergency coronary angiography, they were divided into TMP 0 ~ 1 group (218 cases) and TMP 2 ~ 3 group (98 cases). All patients with TMP level 0 to 1 underwent emergency PCI and were divided into tirofiban (n = 91) and routine treatment (n = 127) according to the use of tirofiban. The relationship between Tirofiban and spontaneous recanalization of infarct-related arteries, myocardial perfusion after PCI, and major cardiac adverse events (MACE) during hospitalization were analyzed. Results The level of triglyceride and leukocyte in TMP grade 2 ~ 3 group was significantly lower than that in TMP 0 ~ 1 group (P <0.05), and the application rate of tirofiban was significantly higher than that in TMP 0 ~ 1 group (P <0.01) ). Subgroup analyzes showed that the TIMI frame number, length of hospital stay, grade 0 to 2 TMP and hospital stay MACE were all decreased (P <0.05) and left ventricular ejection fraction (P < 0.05). In the elderly and tirofiban group, the left ventricular ejection fraction decreased, and the postoperative TMP grade 0 ~ 2 was correlated with the incidence of MACE in hospitalization (P <0.05). Conclusion Early application of tirofiban can increase the spontaneous recanalization rate of infarction-related artery in patients with acute STEMI and improve the myocardial reperfusion and prognosis in hospital after emergency PCI.