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目的探讨老年急性心肌梗死(AMI)患者急诊经皮冠状动脉介入治疗(PCI)联合应用替罗非班的安全性。方法150例AMI患者行急诊PCI时联合应用替罗非班。按年龄≥65岁和<65岁将患者分为老年组(40例)和非老年组(110例),分析两组患者出血并发症和血小板减少症的发生情况。并根据是否达到心肌梗死溶栓试验(TIMI)出血标准将患者分为TIMI出血组(10例)和非TIMI出血组(140例),分析出血的相关危险因素。结果老年组达到TIMI出血标准的发生率有高于非老年组的趋势(12.5%vs4.5%,P=0.132)。logistic多因素分析提示仅有术后即刻的活化部分凝血酶原时间值是发生TIMI出血事件的独立危险因素(P=0.013,OR=1.458)。两组血小板减少症发生率无显著差异(0vs2.7%,P=0.565)。结论在≥65岁的老年AMI患者中,急诊PCI联合应用替罗非班是安全的。
Objective To investigate the safety of percutaneous coronary intervention (PCI) combined with tirofiban in elderly patients with acute myocardial infarction (AMI). Methods A total of 150 AMI patients underwent emergency PCI with tirofiban. The patients were divided into the elderly group (40 cases) and the non-elderly group (110 cases) aged ≥65 years and <65 years old. The incidence of bleeding complications and thrombocytopenia were analyzed in both groups. Patients were divided into TIMI bleeding group (n = 10) and non-TIMI bleeding group (n = 140) according to whether TIMI hemorrhage standard was reached. The related risk factors of hemorrhage were analyzed. Results The incidence of TIMI hemorrhage in the elderly group was higher than that in the non-elderly group (12.5% vs 4.5%, P = 0.132). Logistic multivariate analysis showed that only the postoperative partial prothrombin time was an independent risk factor for TIMI bleeding (P = 0.013, OR = 1.458). There was no significant difference in the incidence of thrombocytopenia between the two groups (0 vs. 2.7%, P = 0.565). Conclusions Emergency T-PCI combined with tirofiban is safe in elderly patients with AMI ≥65 years.