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目的:探讨盐酸替罗非班对非ST段抬高急性冠脉综合征(NSTE-ACS)患者早期介入治疗的疗效和安全性。方法:选择NSTE-ACS的中高危患者95例,随机分为替罗非班试验组(n=48)和对照组(n=47),均于入选后72h内接受早期PCI治疗。比较两组间基础临床资料、PCI前后病变血管血流TIMI分级、术后12h血清肌钙蛋白(cTnT)和肌酸激酶同工酶(CK-MB)水平、出血事件和血小板减少以及30d主要心血管事件(MACE)的发生率。结果:试验组和对照组最终分别入选了47例和44例患者。两组间基础临床资料无统计学差异,试验组应用替罗非班后PCI术前病变血管前向血流达到TIMI3级的比率高于对照组(61.7%vs47.7%,P<0.05),术后TIMI3级血流获得率试验组较对照组高(95.7%vs88.6%),但未达到统计学差异;术后试验组cTNT和CK-MB升高发生率较对照组明显减低(10.6%vs20.5%,P<0.05)。两组出血事件和血小板减少以及30dMACE发生率差异无统计学意义(P>0.05)。结论:NSTE-ACS患者早期介入治疗术前应用盐酸替罗非班是安全有效的,能够提高PCI术前病变血管前向血流,并减少PCI术后的心肌损伤。
Objective: To investigate the efficacy and safety of tirofiban hydrochloride for early interventional therapy in patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS). Methods: Ninety-five middle- and high-risk patients with NSTE-ACS were randomly assigned to tirofiban (n = 48) and control (n = 47), all of whom received early PCI within 72 hours after enrollment. Baseline clinical data were compared between the two groups, TIMI grade of vascular lesion before and after PCI, level of serum cTnT, CK-MB, bleeding and thrombocytopenia at 12th hour after PCI, The incidence of vascular events (MACE). Results: The experimental group and the control group were selected in the final 47 cases and 44 patients. There was no significant difference in basic clinical data between the two groups. The rate of TIMI3 grade of pre-vascular blood flow before PCI in Tirofiban group was higher than that in control group (61.7% vs 47.7%, P <0.05) The postoperative TIMI grade 3 blood flow acquisition rate was higher in the experimental group than in the control group (95.7% vs 88.6%), but the statistical difference was not found. The incidence of elevated cTNT and CK-MB in the experimental group was significantly lower than that in the control group (10.6 % vs20.5%, P <0.05). Bleeding and thrombocytopenia in both groups and 30dMACE had no significant difference (P> 0.05). CONCLUSIONS: Tirofiban hydrochloride is safe and effective before NSTE-ACS treatment in early interventional therapy. It can improve pre-PCI blood flow and reduce myocardial damage after PCI.