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目的探讨替罗非班的应用时机对行冠脉介入治疗(PCI)的高危非ST段抬高型急性冠脉综合征(NSTE-ACS)患者近期临床预后的影响。方法160例高危NSTE-ACS患者随机分为PCI术前早期应用组(Ⅰ组,冠脉造影前4～6h应用替罗非班)和PCI术前即刻应用组(Ⅱ组,导丝通过冠脉病变后应用替罗非班)。分析两组靶血管的心肌梗死溶栓试验(TI MI)血流分级和TI MI心肌灌注分级(TMPG)的差异。随访PCI术后24h、3d、7d和30d内主要不良心血管事件(MACE)的发生率,并记录使用替罗非班治疗期间的出血并发症和血小板减少症的发生率。结果Ⅰ组术前即刻靶血管TI MI血流2～3级(81%)和TMPG灌注2～3级(62%)的比率均显著高于Ⅱ组(分别为62%和33%,P<0.05)。两组PCI术后靶血管TI MI血流3级比率无统计学差异(P>0.05)。Ⅰ组术后TMPG灌注2～3级比率(89%)显著高于Ⅱ组(64%,P<0.05)。两组PCI术后24h和3d内均未发生MACE,7d MACE发生率均为1.25%,两组30d内MACE的发生率分别为3.75%和6.25%(P>0.05)。使用替罗非班治疗期间,两组重度出血的发生率分别为2.50%和1.25%(P>0.05),中度出血并发症和轻度血小板减少症的发生率均为1.25%。结论在应用阿司匹林、氯吡格雷行抗血小板治疗的基础上,高危NSTE-ACS患者于PCI术前早期(4～6h)应用替罗非班较PCI术前即刻应用,能更显著改善冠脉血流和心肌灌注,并有降低PCI术后30d内MACE发生率的趋势。
Objective To investigate the effect of tirofiban on the short-term prognosis of patients with high-risk non-ST-segment elevation acute coronary syndrome (NSTE-ACS) undergoing coronary intervention (PCI). Methods One hundred and sixty patients with high risk NSTE-ACS were randomly divided into two groups: primary pre-PCI group (group Ⅰ, tirofiban 4 to 6 hours before coronary angiography) and group before PCI (group Ⅱ, Tirofiban after the lesion). Differences in TI MI and TI MI myocardial perfusion grading (TMPG) between the two groups of target vessels were analyzed. The incidence of major adverse cardiovascular events (MACE) at 24 h, 3 d, 7 d, and 30 d after PCI was followed up and the incidence of bleeding complications and thrombocytopenia during and after treatment with tirofiban was recorded. Results The rate of TI MI blood flow grade 2 ~ 3 (81%) and TMPG perfusion grade 2 ~ 3 (62%) in group Ⅰ were significantly higher than that in group Ⅱ (62% and 33%, P < 0.05). There was no significant difference in the grade 3 TI TI flow between the two groups (P> 0.05). The rate of TMPG perfusion in group Ⅰ ~ Ⅱ (89%) was significantly higher than that in group Ⅱ (64%, P <0.05). The incidence of MACE was no significant difference between the two groups within 24h and 3d after PCI, and the incidence of MACE on 7d was 1.25%. The incidence of MACE within 30d in both groups were 3.75% and 6.25% respectively (P> 0.05). During the treatment with tirofiban, the rates of severe bleeding in both groups were 2.50% and 1.25%, respectively (P> 0.05). The incidence of moderate bleeding complications and mild thrombocytopenia were both 1.25%. Conclusion In the application of aspirin and clopidogrel antiplatelet therapy, high-risk patients with NSTE-ACS at early stage of PCI (4 ~ 6h) should be treated with tirofiban immediately before PCI, which can significantly improve coronary blood flow Flow and myocardial perfusion, and reduce the trend of MACE incidence within 30 days after PCI.