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>仅冠状动脉内应用依替巴肽与仅冠状动脉内应用替罗非班对行直接经皮冠状动脉介入治疗术的急性 ST 段抬高型心肌梗死患者的安全性比较
仅冠状动脉内应用依替巴肽与仅冠状动脉内应用替罗非班对行直接经皮冠状动脉介入治疗术的急性 ST 段抬高型心肌梗死患者的安全性比较
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摘要
背景对于行直接经皮冠状动脉介入治疗（PCI）术的急性 ST 段抬高型心肌梗死（STEMI）患者，持续静脉应用小分子血小板糖蛋白（GP）Ⅱb/Ⅲa 受体抑制剂（GPI）可改善患者的预后，但会增加患者的出血事件，因此，仅冠状动脉内应用依替巴肽与仅冠状动脉内应用替罗非班的安全性值得探索。目的比较仅冠状动脉内应用依替巴肽与仅冠状动脉内应用替罗非班对行直接 PCI 术的急性 STEMI 患者的安全性。方法回顾性选取2014年3月—2015年9月大连市中心医院收治的符合纳入标准的急性 STEMI 患者135例，根据 PCI 术中不同用药情况分为依替巴肽组62例和替罗非班组73例。收集两组患者的一般资料，包括年龄、性别、体质指数、吸烟、糖尿病、高血压、早发冠心病家族史、Killip 分级Ⅱ级及以上、术后药物（β-受体阻滞剂、血管紧张素转换酶抑制剂）应用情况、前壁心肌梗死、梗死相关动脉〔左前降支（LAD）、左回旋支（LCX）、右冠状动脉（RCA）〕、基线心肌梗死溶栓治疗（TIMI）血流分级0~1级、发病至球囊扩张时间、血栓抽吸情况。比较两组患者术后 TIMI 血流分级、校正的 TIMI 血流帧数（cTFC）、ST 段回落情况、左心室射血分数（LVEF）、左心室舒张末期内径（LVEDD）、室壁运动异常发生率，住院期间出血事件、血小板减少、术后30 d 主要不良心血管事件（包括全因死亡、支架内血栓、紧急冠状动脉血运重建术、心肌梗死）发生率。结果两组患者年龄、性别、体质指数、吸烟率、糖尿病发生率、高血压发生率、早发冠心病家族史阳性率、Killip 分级Ⅱ级及以上发生率、术后药物（β-受体阻滞剂、血管紧张素转换酶抑制剂）应用情况、前壁心肌梗死发生率、梗死相关动脉、基线 TIMI 血流分级0~1级率、发病至球囊扩张时间、血栓抽吸率比较，差异无统计学意义（P ＞0.05）。两组患者术后 TIMI 血流分级、cTFG、ST 段回落情况、LVEF、LVEDD、室壁运动异常发生率比较，差异无统计学意义（P ＞0.05）。替罗非班组患者住院期间血小板减少发生率高于依替巴肽组（P ＜0.05）；两组患者住院期间出血事件、术后30 d 主要不良心血管事件发生率比较，差异无统计学意义（P ＞0.05）。结论直接 PCI 术中仅冠状动脉内应用依替巴肽或替罗非班治疗策略均具有良好的治疗效果，且仅冠状动脉内应用依替巴肽的安全性更高。%Background Continuous intravenous infusion of small molecule platelet glycoprotein( GP)Ⅱ b/ Ⅲ a receptor antagonist(GPI)can improve the prognosis of patients with acute ST - segment elevation myocardial infarction(STEMI) who had undergone primary percutaneous coronary intervention(PCI). However,this treatment method can increase bleeding events. Therefore,the safety of the intracoronary eptifibatide only strategy and the intracoronary tirofiban only strategy are worth exploring. Objective To compare the safety of intracoronary eptifibatide only strategy or intracoronary tirofiban only strategy during primary PCI of acute STEMI patients. Methods A total of 135 cases of acute STEMI patients admitted into Dalian Municipal Center Hospital from March 2014 to September 2015 and in line with the inclusion standards retrospectively,which were divided into eptifibatide group(n = 62)and tirofiban group(n = 73)according to the intracoronary eptifibatide or tirofiban during primary PCI. The baseline characteristics of patients in the two groups were collected,including age,gender,body mass index,smoking,diabetes,hypertension,premature family history of coronary artery disease,Killip Ⅱ class and above, postoperative drug( β receptor blocker and ACE inhibitor)application,anterior wall myocardial infarction,infarct - related artery(left anterior descending,left circumflex artery,right coronary artery),baseline thrombolysis in myocardial infarction (TIMI)flow grade of 0 or 1,the time from onset to balloon dilatation and thrombus aspiration. The TIMI flow grade,corrected TIMI frame count(cTFG),ST - segment resolution,left ventricular ejection fraction( LVEF),left ventricular end diastolic diameter(LVEDD),ventricular wall motion abnormalities,the incidence of bleeding events and thrombocytopenia in hospital, as well as the incidence of major adverse cardiac events( including all - cause death,stent thrombosis,emergency coronary revascularization,myocardial infarction)on 30 days after PCI of patients were compared between the two groups after completion of primary PCI. Results The difference between the two groups in age,gender,body mass index,smoking,diabetes positive rate,hypertension positive rate,positive rate of premature family history of coronary artery disease,incurrence of Killip Ⅱ class and above,postoperative drug application(β receptor blocker and ACE inhibitor),anterior wall myocardial infarction,infarct related artery,baseline TIMI flow grade of 0 or 1,time from onset to balloon dilatation and thrombus aspiration were not statistically significant(P > 0. 05). The difference between the two groups in TIMI flow grade,cTFG,ST - segment resolution, LVEF,LVEDD and ventricular wall motion abnormalities of patients after completion of primary PCI were not statistically significant(P > 0. 05). The incidence of thrombocytopenia in tirofiban group was higher than eptifibatide group(P < 0. 05). The difference between the two groups of incidence of bleeding events in hospital and major adverse cardiac events on 30 days after PCI were not statistically significant(P > 0. 05). Conclusion The intracoronary eptifibatide only strategy and the intracoronary tirofiban only strategy have satisfactory curative effect during primary PCI of acute STEMI patients,however,the intracoronary eptifibatide only strategy seems to be safer.
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