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目的:评价静脉内和冠脉内同时应用负荷剂量替罗非班在急性ST段抬高心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)中的疗效和安全性。方法:43例拟行急诊PCI术STEMI患者随机选入替罗非班IV组(仅静脉内推注负荷剂量替罗非班,22例)和替罗非班IV&IC组(静脉内和冠脉内同时推注负荷剂量替罗非班,21例),观察患者PCI术前术后thrombolysis in myocardial infarction trial(TIMI)血流分级和心肌组织灌注,住院期间心脏超声、主要不良心血管事件(MACE)、出血事件和血小板减少,以及术后30d的MACE。结果:两组患者的基础临床情况和术前冠脉造影特征差异无统计学意义;两组患者术后TIMI血流分级,校正的TIMI帧数计数(CTFC)≤27帧差异无统计学意义;术后心电图ST段抬高总和回落(sumSTR)百分比≥70%,肌钙蛋白I(cTnI)与肌酸激酶同工酶(CK-MB)峰值浓度等差异无统计学意义;住院期间左室收缩功能、MACE、大量出血事件、血小板减少症的发生率等差异无统计学意义;两组术后30dMACE发生率差异无统计学意义。结论:在STEMI患者急诊PCI术中,静脉内和冠脉内同时应用负荷剂量替罗非班是安全的,近期疗效与单纯静脉内应用替罗非班相当。
PURPOSE: To evaluate the efficacy and safety of intravenous and intracoronary load-loading tirofiban in emergency percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). METHODS: Forty-three STEMI patients undergoing emergency PCI were enrolled in a randomized, placebo-controlled, tirofiban-IV group (tirofiban only with an intravenous bolus dose of 22) and tirofiban IV & IC (intravenous and intracoronary (Tirofiban, 21 cases) were enrolled in this study. The blood flow and myocardial perfusion of thrombolysis in myocardial infarction trial (TIMI), cardiac ultrasound during hospitalization, major adverse cardiovascular events (MACE) Bleeding events and thrombocytopenia, and MACE after 30 days. Results: There was no significant difference between baseline and preoperative coronary angiography in the two groups. There was no significant difference between the two groups in postoperative TIMI flow classification and corrected TIMI frame count (CTFC) ≤27 frames. There was no significant difference in peak value of ST-ST elevation (sumSTR) or ≥70%, peak cTnI and CK-MB concentration in postoperative electrocardiogram, left ventricular systolic There was no significant difference in the incidence of MACE, massive bleeding, and thrombocytopenia between the two groups. There was no significant difference in the incidence of MACE between the two groups at 30 days. CONCLUSIONS: Tirofiban is safe for both intravenous and intracoronary loading doses in patients with STEMI during emergency PCI. The immediate effect is comparable to intravenous tirofiban alone.