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目的:评价血栓抽吸加替罗非班对急性ST段抬高型心肌梗死(STEMI)患者的疗效。方法:回顾性分析行直接经皮冠状动脉介入(PPCI)治疗的STMEI患者,根据是否使用血栓抽吸或替罗非班,将患者分为4组:标准PPCI组(SP组),替罗非班组(TI组),血栓抽吸组(AT组),血栓抽吸+替罗非班组(AT+TI组)。观察各组患者心肌显影分级(MBG)和心电图ST段回落(STR)情况。随访2年,统计心因性死亡、心因性死亡和非致死性心肌梗死复合终点及主要不良心血管事件。结果:心肌再灌注在AT+TI组明显改善(MBG≥2,P=0.008;STR≥70%,P=0.005);心因性死亡、心因性死亡和非致死性心肌梗死复合终点及主要心血管不良事件患者的心肌再灌注明显变差(MBG≥2,均P<0.01;STR≥70%,均P<0.01)。2年随访发现,血栓抽吸加替罗非班能明显降低STEMI患者心因性死亡(P=0.008)、心因性死亡和非致死性心肌梗死复合终点(P=0.006)及主要心血管不良事件(P=0.009)。结论:血栓抽吸+替罗非班能改善STEMI患者临床预后。
Objective: To evaluate the efficacy of thrombolysis plus tirofiban in patients with acute ST-segment elevation myocardial infarction (STEMI). METHODS: We retrospectively analyzed STMEI patients undergoing direct percutaneous coronary intervention (PPCI). Patients were divided into 4 groups according to whether thrombus aspiration or tirofiban was used: standard PPCI (SP), tirofiban (TI group), thrombus aspiration group (AT group) and thrombolysis + tirofiban group (AT + TI group). The myocardial imaging grading (MBG) and ST segment depression (STR) of the patients in each group were observed. The patients were followed up for 2 years to analyze the cause of death from complication, the composite end point of cardiac death and non-fatal myocardial infarction and major adverse cardiovascular events. Results: Myocardial reperfusion was significantly improved in AT + TI group (MBG≥2, P = 0.008; STR≥70%, P = 0.005). The composite end points of cardiac death, cardiac death and non-fatal myocardial infarction and major Myocardial reperfusion was significantly worse in patients with cardiovascular events (MBG ≥ 2, all P <0.01; STR ≥ 70%, both P <0.01). Two-year follow-up found that thrombus aspiration plus tirofiban significantly reduced cardiac death in STEMI patients (P = 0.008), composite end points for cardiac death and non-fatal myocardial infarction (P = 0.006), and major adverse cardiovascular events Event (P = 0.009). Conclusion: Thrombus aspiration + tirofiban can improve the clinical prognosis of STEMI patients.