经血栓抽吸导管注射替罗非班和三磷酸腺苷对重度血栓负荷急性前壁心肌梗死患者急诊PCI效果的影响

Li Zhilong; Wang Wanhong; Ding Hao; Zhang Ronglin; Zhou Hao

摘要

目的探讨急诊经皮冠状动脉介入治疗(PCI)时,经血栓抽吸导管冠状动脉(冠脉)内注射替罗非班和三磷酸腺苷对重度血栓负荷急性前壁心肌梗死患者心肌灌注和临床预后的影响.方法连续入选2015年1月至2017年12月于南京鼓楼医院集团宿迁市人民医院心血管内科行急诊冠状动脉造影后提示靶病变为重度血栓负荷的急性前壁心肌梗死患者162例为研究对象.急诊PCI时,采用随机数字表法将患者随机分为单纯血栓抽吸组(A组,n=54)、血栓抽吸联合冠脉内注射替罗非班组(B组,n=54)和血栓抽吸联合冠脉内注射替罗非班和三磷酸腺苷组(C组,n=54).比较3组患者的临床基线资料;急诊PCI前、术后的冠脉造影结果;心电图ST段回落不良发生率;肌酸激酶同工酶(CK-MB)峰值、肌钙蛋白I峰值、N-端脑钠肽前体(NT-proBNP)水平、左心室射血分数(LVEF)、住院以及随访期间主要不良心血管事件的发生情况.结果 3组患者的临床基线资料和冠脉造影资料差异均无统计学意义(P均＞0.05).术后校正心肌梗死溶栓实验血流计帧(CTFC)分级正常血流的比例C组高于A组和B组(90.7% vs. 68.5%、74.1%,P均＜0.05).术后心肌梗死溶栓实验心肌染色分级(MBG)3级的比例C组高于A组和B组(88.9% vs. 70.4%、72.2%,P均＜0.05).术后心电图ST段回落不良发生率C组低于A组和B组(7.4% vs. 25.9%、24.1%,P均＜0.05).术后3组患者CK-MB和肌钙蛋白I峰值差异均无统计学意义(P均＞0.05).术后NT- proBNP水平C组低于A组和B组[(983.8±269.8)ng/L vs.(1145.4±392.5) ng/L、(1125.1±378.1)ng/L,P均＜0.05].术后5~7 d LVEF C组高于A组和B组[(52.9±6.7)% vs.(48.9 ±8.5)%、(49.6±8.3)%,P均＜0.05].术后3组患者30 d死亡率、再发心肌梗死率和靶血管再次血运重建(TVR)发生率比较,差异均无统计学意义(P均＞0.05),但术后总 MACEs发生率C组低于A组和B组(3.7% vs. 18.5%、16.7%,P均＜0.05).3组患者术后出血事件的比例差异无统计学意义(P＞0.05).结论对于行急诊PCI的重度血栓负荷急性前壁心肌梗死患者,血栓抽吸联合替罗非班和三磷酸腺苷冠状动脉内注射与单纯血栓抽吸及血栓抽吸联合冠状动脉内注射替罗非班相比,可以获得更好的心肌再灌注、改善心功能并降低PCI后30 d的总MACEs发生率,且不增加出血事件.%Objective To investigate the effects of intracoronary injection of tirofiban and adenosine triphosphate on myocardial perfusion and clinical prognosis in patients with severe anterior myocardial infarction with severe thrombus stress during emergency percutaneous coronary intervention (PCI). Methods Between January 2015 and December 2017, 162 patients with acute anterior wall myocardial infarction who underwent emergency coronary angiography in the Department of Cardiology, Suqian People's Hospital of Nanjing Drum Tower Hospital Group, were selected as subjects. At the time of emergency PCI, patients were randomized into a simple thrombus aspiration group (group A, n=54), thrombus aspiration combined with intracoronary injection of tirofiban (group B, n=54) and thrombus. Aspiration was combined with intracoronary injection of tirofiban and adenosine triphosphate (group C, n=54). Baseline clinical data, angiographic features before and after primary percutaneous coronary intervention (PCI), percentage of imperfect ST-segment resolution, CK-MB peak value, troponin I peak value, NT-proBNP, left ventricular ejection fraction (LVEF) and major adverse cardiovascular events after PCI among 3 groups were compared. Results There were no significant differences in clinical baseline data and coronary angiography data between the 3 groups (all P>0.05). The proportion of normal blood flow in the corrected blood flow meter frame (CTFC) of the myocardial infarction thrombolysis was higher in group C than in group A and group B (90.7% vs. 68.5%, 74.1%, P0.05). Postoperative NT-proBNP levels were lower in group C than in group A and group B [(983.8±269.8) ng/L vs. (1145.4±392.5) ng/L, (1125.1±378.1) ng/L, P0.05), but the total MACEs after surgery. The group C was lower than group A and group B (3.7% vs. 18.5%, 16.7%, P0.05). Conclusions Comparing with thrombus aspiration alone and thrombus aspiration and intracoronary tirofiban bolus injection, intracoronary bolus injection of tirofiban combined with adenosine triphosphate through thrombus aspiration catheter after thrombus aspiration can get better myocardial reperfusion and heart function and reduce 30-days MACEs after PCI without increasing bleeding complication in patients with acute anterior myocardial infarction and heavy thrombosis burden undergoing primary PCI.

经血栓抽吸导管注射替罗非班和三磷酸腺苷对重度血栓负荷急性前壁心肌梗死患者急诊PCI效果的影响

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