CAJ | 학술논문

目的探讨老年急性冠状动脉综合征(ACS)患者经皮冠状动脉介入术(PCI)中应用替罗非班的疗效和安全性. 方法将256例高危ACS患者,随机分为替罗非班组(替罗非班+PCI,130例)和常规PCI组(126例),替罗非班组又根据年龄分为老年组(68例,≥60岁)和非老年组(62例,<60岁)2个亚组.两组患者PCI术后罪犯血管的心肌梗死溶栓治疗(TIMI)3级血流达标率、校正的TIMI帧计数(CTFC)、心肌灌注分级(TMPG),以及36 h和30 d的主要心脏不良事件发生率作为疗效观察指标.并观察两组患者术后血小板减少和出血并发症的发生率. 结果替罗非班组PCI术后TIMI3级血流发生率较常规PCI组高,但差异无统计学意义(93.6%比91.3%,χ~2=1.02,P=0.313),TMPG 3级所占比例替罗非班组高于PCI组(83.1%比67.5%,χ~2=4.05,P=0.046),CTFC示替罗非班组血流快于PCI组(31.6±7.7比23.8±6.1,t=2.49,P=0.026).两组在36 h和30 d的主要心脏不良事件发生率差异均有统计学意义(6.9%比19.0%,χ~2=6.30,P=0.013;3.8%比11.90%,χ~2=5.82,P=0.018).与常规PCI组比较,替罗非班组TIMI轻度出血的发生率有增加趋势(20.2%比15.2%,χ~2=3.65,P=0.065).亚组分析表明,老年组轻度出血并发症的发生率较非老年组稍增高(25.0%比14.5%,χ~2=4.98,P=0.026),但两组严重出血事件发生率和血小板减少发生率均相似. 结论老年ACS患者介入术中使用替罗非班是有效和安全的,其疗效优于常规治疗,但轻度出血风险有可能增加.
목적 탐토노년급성관상동맥종합정(ACS)환자경피관상동맥개입술(PCI)중응용체라비반적료효화안전성. 방법 장256례고위ACS환자,수궤분위체라비반조(체라비반+PCI,130례)화상규PCI조(126례),체라비반조우근거년령분위노년조(68례,≥60세)화비노년조(62례,<60세)2개아조.량조환자PCI술후죄범혈관적심기경사용전치료(TIMI)3급혈류체표솔、교정적TIMI정계수(CTFC)、심기관주분급(TMPG),이급36 h화30 d적주요심장불량사건발생솔작위료효관찰지표.병관찰량조환자술후혈소판감소화출혈병발증적발생솔. 결과 체라비반조PCI술후TIMI3급혈류발생솔교상규PCI조고,단차이무통계학의의(93.6%비91.3%,χ~2=1.02,P=0.313),TMPG 3급소점비례체라비반조고우PCI조(83.1%비67.5%,χ~2=4.05,P=0.046),CTFC시체라비반조혈류쾌우PCI조(31.6±7.7비23.8±6.1,t=2.49,P=0.026).량조재36 h화30 d적주요심장불량사건발생솔차이균유통계학의의(6.9%비19.0%,χ~2=6.30,P=0.013;3.8%비11.90%,χ~2=5.82,P=0.018).여상규PCI조비교,체라비반조TIMI경도출혈적발생솔유증가추세(20.2%비15.2%,χ~2=3.65,P=0.065).아조분석표명,노년조경도출혈병발증적발생솔교비노년조초증고(25.0%비14.5%,χ~2=4.98,P=0.026),단량조엄중출혈사건발생솔화혈소판감소발생솔균상사. 결론 노년ACS환자개입술중사용체라비반시유효화안전적,기료효우우상규치료,단경도출혈풍험유가능증가.
Objective To investigate the efficacy and safety of tirofiban in the treatment of aged patients with acute coronary syndrome (ACS) during primary percutaneous coronary intervention (PCI). Methods Two hundred and fifty-six patients with ACS who underwent primary PCI were randomly divided into two groups: tirofiban group (tirofiban + PCI treatment, n= 130) and control group (routine PCI treatment, n = 126). Tirofiban group was further divided into two subgroups according to the age: aged group(age ≥60 years, n= 68) and non-elderly group(age<60 years, n=62). At the end of PCI procedure, angiographic features such as thrombolysis in myocardial infarction (TIMI) flow grade, corrected TIMI frames count and TIMI myocardial perfusion grades (TMPG) were analyzed immediately. The incidence of major adverse cardiac events (MACE) was observed within 36 hours and 30 days after PCI, and the incidence rates of thrombocytopenia and bleeding were assessed. Results There was no significant difference between both the two study groups and the two subgroups in the basic clinical or angiographic characteristics before PCI (all P>0.05). There was no significant difference between two groups in TIMI 3 flow achievement rate in culprit vessels after PCI (93.6% vs. 91.3%, χ~2 = 1.02, P= 0.313). In tirofiban group, corrected TIMI frames count was significantly higher than that in control group (31.6±7.7 vs. 23.8±6.1, t = 2.49, P 0.026), and TMPG 3 achievement rate was also higher (83.1% vs. 67.5% ,χ~2=4.05, P=0.046). The incidence of MACE was significantly lower in tirofiban group than that in control group both within 36 hours and 30 days after procedure(6.9% vs. 19.0%, χ~2= 6.30, P= 0.013; 3.8% vs. 11.90%, χ~2= 5.82,P=0.018, respectively). No statistical difference was found in mild bleeding complications between the two groups (20.2% vs. 15.2%, χ~2 =3.65, P=0.065), but the incidence of mild bleeding was higher in aged group than that in the non-elderly group(25.0% vs. 14.5%,χ~2=4.98, P=0.026), and the incidences of serious bleeding and thrombocytopenia were similar between the two subgroups. Conclusions Intravenous tirofiban infusion is safe in aged ACS patients during primary PCI, and has favorable short-term outcomes compared with routine treatment, although there is a slight risk of mild bleeding.