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目的:前瞻性评价替罗非班对急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)术后肌酸激酶混合型同工酶、肌钙蛋白I、酶性心肌梗死面积以及主要心脏不良事件(MACE)发生率的影响。方法:183例接受急诊PCI治疗的STEMI患者,随机分为替罗非班组(92例)和对照组(91例)。比较两组基础临床情况、介入治疗结果、急诊PCI术前和术后血清肌酸激酶混合型同工酶、肌钙蛋白I、酶性心肌梗死面积、住院期和术后180天左心室射血分数及MACE发生率。结果:替罗非班组与对照组相比,基础临床情况、介入治疗结果及术前肌酸激酶混合型同工酶、肌钙蛋白I水平差异均不具有统计学意义(P>0.05)。替罗非班组与对照组相比,急诊PCI术后肌酸激酶混合型同工酶峰值(P<0.01)和肌酸激酶混合型同工酶均值(P<0.01)、肌钙蛋白I峰值(P=0.01)和肌钙蛋白I均值(P<0.05)、酶性心肌梗死面积(P<0.05)均显著降低,差异均具有统计学意义。替罗非班组与对照组相比,住院期及术后180天左心室射血分数(P<0.05～0.01)明显增加,MACE发生率(P<0.05)显著降低,差异均具有统计学意义。多因素回归分析表明,替罗非班治疗是降低STEMI患者急诊PCI术后180天MACE发生率的独立决定因素(OR=0.39,P<0.01)。替罗非班组术后出血并发症发生率高于对照组,但差异不具有统计学意义(P>0.05)。结论:替罗非班能显著降低STEMI患者急诊PCI术后肌酸激酶混合型同工酶、肌钙蛋白I峰值和均值,明显缩小酶性心肌梗死面积,并显著改善住院期及术后180天临床预后。
OBJECTIVE: To prospectively evaluate the effects of tirofiban on creatine kinase - type isoenzyme, troponin I, enzyme activity after percutaneous coronary intervention (PCI) in patients with acute ST - elevation myocardial infarction (STEMI) Myocardial infarct size and the incidence of major cardiac adverse events (MACE). Methods: A total of 183 STEMI patients undergoing emergency PCI were randomly assigned to tirofiban (n = 92) and control (n = 91). Baseline clinical outcomes, interventional outcome, serum creatine kinase isoenzyme, troponin I, area of myocardial infarction, hospitalization, and left ventricular ejection fraction Score and MACE incidence. Results: Compared with control group, the results of basic clinical conditions, interventional treatment and preoperative creatine kinase mixed type and troponin I levels were not statistically significant (P> 0.05). Tirofiban group compared with the control group, the peak of creatine kinase (P <0.01) and creatine kinase (P <0.01), peak of troponin I (P < P = 0.01), and the average value of troponin I (P <0.05), and the area of myocardial infarction (P <0.05) were significantly lower, the differences were statistically significant. Tirofiban group compared with the control group, hospitalization and left ventricular ejection fraction 180 days after surgery (P <0.05 ~ 0.01) increased significantly, MACE incidence (P <0.05) decreased significantly, the differences were statistically significant. Multivariate regression analysis showed that tirofiban was an independent determinant of MACE incidence (OR = 0.39, P <0.01) at 180 days after PCI in STEMI patients. The incidence of postoperative bleeding complications in tirofiban group was higher than that in control group, but the difference was not statistically significant (P> 0.05). CONCLUSION: Tirofiban can significantly reduce peak and mean creatine kinase (MHC) isoenzyme and troponin I after STEMI in patients with STEMI, significantly reduce the area of myocardial infarction, and significantly improve the hospitalization and postoperative 180 days Clinical prognosis.