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目的:研究替罗非班联合血栓抽吸导管预处理对急性ST段抬高型心肌梗死(STEMI)患者即刻或择期经皮冠状动脉介入(PCI)治疗的临床疗效和安全性的影响。方法:纳入102例经急诊冠状动脉造影显示罪犯血管前向血流TIMI 0级,且伴有明显血栓负荷影像的STEMI患者。应用替罗非班联合血栓抽吸导管预处理至前向血流恢复TIMI 3级后,随机分为即刻PCI治疗组(n=52)及择期(7~10d后)PCI治疗组(n=50)。比较两组患者冠脉支架植入情况,PCI治疗中慢血流或无复流事件发生率,住院期间主要心血管事件发生率及PCI治疗后4周左室射血分数(LVEF)。结果:择期PCI治疗组冠脉支架植入成功率显著高于即刻PCI治疗组(100%vs 86.54%,P<0.05),且使用支架数量较少;即刻PCI治疗组治疗中慢血流或无复流事件的发生率为9.62%,择期PCI治疗组无1例发生,差异有统计学意义(P<0.05);即刻PCI治疗组患者住院期间主要心血管事件发生率为7.69%,择期PCI治疗组为0,差异有统计学意义(P<0.05);PCI治疗后4周两组患者LVEF比较差异无统计学意义(P>0.05)。结论:经替罗非班联合血栓抽吸导管预处理达TIMI 3级血流的STEMI患者行后续择期PCI治疗比即刻PCI治疗有更好的临床疗效,且安全性明显提高。
Objective: To investigate the clinical efficacy and safety of tirofiban combined with thrombus aspiration catheter in the treatment of immediate or selective percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods: A total of 102 patients with STEMI who had undergone emergency coronary angiography and had TIMO grade 0 in the bloodstream of the culprit before the thrombus were included. The rats were randomly divided into immediate PCI group (n = 52) and elective PCI (n = 50) group after PCI (n = 50) ). Coronary stent placement, PCI incidence of slow or no-reflow events, major cardiovascular events during hospitalization, and left ventricular ejection fraction (LVEF) 4 weeks after PCI were compared. Results: The success rate of coronary stent implantation in elective PCI group was significantly higher than that of immediate PCI group (100% vs 86.54%, P <0.05), and the number of stents was less than that of PCI group (P <0.05). The incidence of major cardiovascular events during in-hospital PCI was 7.69% in the immediate PCI group, while the elective PCI treatment The difference was statistically significant (P <0.05). There was no significant difference in LVEF between the two groups at 4 weeks after PCI (P> 0.05). CONCLUSIONS: STEMI patients treated with tirofiban combined with thrombus aspiration catheters have better clinical efficacy and safety than those treated with immediate PCI in STEMI patients with TIMI grade 3 blood flow.