中华心血管病杂志
中華心血管病雜誌
중화심혈관병잡지
Chinese Journal of Cardiology
2010年
10期
880-885
,共6页
李世英%颜红兵%王健%宋莉%吴铮%迟云鹏%郑斌%赵汉军%李庆祥%张晓江%李文铮%刘臣
李世英%顏紅兵%王健%宋莉%吳錚%遲雲鵬%鄭斌%趙漢軍%李慶祥%張曉江%李文錚%劉臣
리세영%안홍병%왕건%송리%오쟁%지운붕%정빈%조한군%리경상%장효강%리문쟁%류신
心肌梗死%血管成形术,经腔,经皮冠状动脉%替罗非班
心肌梗死%血管成形術,經腔,經皮冠狀動脈%替囉非班
심기경사%혈관성형술,경강,경피관상동맥%체라비반
Myocardial infarction%Angioplasty. transluminal. percutaneous coronary%Tirofiban
目的 评价在ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入治疗(PCI)中联合应用血栓抽吸和经抽吸导管梗死相关动脉内注射替罗非班的有效性和安全性.方法 试验分为2组:血栓抽吸+替罗非班组:2007年1月至2009年3月108例STEMI患者进行血栓抽吸后经抽吸导管梗死相关动脉内应用替罗非班500μg,置入支架后静脉滴注12 h替罗非班0.1μg·kg-1·min-1;单纯血栓抽吸组:2005年1月至2006年12月108例STEMI患者血栓抽吸后置人支架.主要终点:PCI术后即刻心肌梗死溶栓试验(TIMI)血流、术后90 min完全ST段回落率、肌酸激酶同工酶(CK-MB)和肌钙蛋白I峰值.二级终点:住院期间和9个月随访左心室射血分数、主要不良心血管事件(靶血管重建、再次心肌梗死、死亡)和出血事件.结果 两组患者基线特征差异无统计学意义.血栓抽吸+替罗非班组与单纯血栓抽吸组TIMI 3级血流率分别为97.22%和87.04%(P=0.011),完全ST段回落率分别是66.67%和50.91%(P=0.047),CK-MB峰值分别是83.9(68.9～310.5)U/L和126.1(74.7～356.7)U/L(P=0.034),肌钙蛋白Ⅰ峰值分别是42.7(14.7～113.9)μg/L和72.5(59.8～135.3)μg/L(P=0.029).住院期间,血栓抽吸+替罗非班组和单纯血栓抽吸组的左心室射血分数分别为(45.7±10.8)%和(42.9±9.9)%(P=0.049).9个月随访显示,血栓抽吸+替罗非班组主要不良心血管事件有降低趋势(log rank χ2=2.865,P=0.09).两组间出血事件差异无统计学意义.结论 直接PCI中联合应用血栓抽吸和经抽吸导管在梗死相关动脉内超选择应用替罗非班可以改善心肌灌注.
目的 評價在ST段抬高型心肌梗死(STEMI)患者直接經皮冠狀動脈介入治療(PCI)中聯閤應用血栓抽吸和經抽吸導管梗死相關動脈內註射替囉非班的有效性和安全性.方法 試驗分為2組:血栓抽吸+替囉非班組:2007年1月至2009年3月108例STEMI患者進行血栓抽吸後經抽吸導管梗死相關動脈內應用替囉非班500μg,置入支架後靜脈滴註12 h替囉非班0.1μg·kg-1·min-1;單純血栓抽吸組:2005年1月至2006年12月108例STEMI患者血栓抽吸後置人支架.主要終點:PCI術後即刻心肌梗死溶栓試驗(TIMI)血流、術後90 min完全ST段迴落率、肌痠激酶同工酶(CK-MB)和肌鈣蛋白I峰值.二級終點:住院期間和9箇月隨訪左心室射血分數、主要不良心血管事件(靶血管重建、再次心肌梗死、死亡)和齣血事件.結果 兩組患者基線特徵差異無統計學意義.血栓抽吸+替囉非班組與單純血栓抽吸組TIMI 3級血流率分彆為97.22%和87.04%(P=0.011),完全ST段迴落率分彆是66.67%和50.91%(P=0.047),CK-MB峰值分彆是83.9(68.9～310.5)U/L和126.1(74.7～356.7)U/L(P=0.034),肌鈣蛋白Ⅰ峰值分彆是42.7(14.7～113.9)μg/L和72.5(59.8～135.3)μg/L(P=0.029).住院期間,血栓抽吸+替囉非班組和單純血栓抽吸組的左心室射血分數分彆為(45.7±10.8)%和(42.9±9.9)%(P=0.049).9箇月隨訪顯示,血栓抽吸+替囉非班組主要不良心血管事件有降低趨勢(log rank χ2=2.865,P=0.09).兩組間齣血事件差異無統計學意義.結論 直接PCI中聯閤應用血栓抽吸和經抽吸導管在梗死相關動脈內超選擇應用替囉非班可以改善心肌灌註.
목적 평개재ST단태고형심기경사(STEMI)환자직접경피관상동맥개입치료(PCI)중연합응용혈전추흡화경추흡도관경사상관동맥내주사체라비반적유효성화안전성.방법 시험분위2조:혈전추흡+체라비반조:2007년1월지2009년3월108례STEMI환자진행혈전추흡후경추흡도관경사상관동맥내응용체라비반500μg,치입지가후정맥적주12 h체라비반0.1μg·kg-1·min-1;단순혈전추흡조:2005년1월지2006년12월108례STEMI환자혈전추흡후치인지가.주요종점:PCI술후즉각심기경사용전시험(TIMI)혈류、술후90 min완전ST단회락솔、기산격매동공매(CK-MB)화기개단백I봉치.이급종점:주원기간화9개월수방좌심실사혈분수、주요불양심혈관사건(파혈관중건、재차심기경사、사망)화출혈사건.결과 량조환자기선특정차이무통계학의의.혈전추흡+체라비반조여단순혈전추흡조TIMI 3급혈류솔분별위97.22%화87.04%(P=0.011),완전ST단회락솔분별시66.67%화50.91%(P=0.047),CK-MB봉치분별시83.9(68.9～310.5)U/L화126.1(74.7～356.7)U/L(P=0.034),기개단백Ⅰ봉치분별시42.7(14.7～113.9)μg/L화72.5(59.8～135.3)μg/L(P=0.029).주원기간,혈전추흡+체라비반조화단순혈전추흡조적좌심실사혈분수분별위(45.7±10.8)%화(42.9±9.9)%(P=0.049).9개월수방현시,혈전추흡+체라비반조주요불양심혈관사건유강저추세(log rank χ2=2.865,P=0.09).량조간출혈사건차이무통계학의의.결론 직접PCI중연합응용혈전추흡화경추흡도관재경사상관동맥내초선택응용체라비반가이개선심기관주.
Objective To investigate whether thrombus aspiration plus intra-infarct-related artery bolus administration of tirofiban via the aspiration catheter is superior to thrombus aspiration alone in improving myocardial perfusion in patients with ST-elevation myocardial infarction (STEMI) undergoing primary angioplasty. Methods In this single center retrospective study, 108 patients with STEMI who underwent angioplasty after thrombus aspiration plus intra-infarction related artery 500 μg tirofiban administration, with subsequent 12-hour intravenous infusion of 0. 1 pg · kg-1 · min-1 after angioplasty (thrombus aspiration + tirofiban group) and 108 matched control patients with STEMI who underwent angioplasty after thrombus aspiration (thrombus aspirartion group ). The primary end points included thrombolysis in myocardial infarction (T1MI) flow immediately after angioplasty, complete ST-segnent elevation resolution ( ＞70% ) at 90 minutes after angioplasty and the peak of creatine kinase-MB (CK-MB)and troponin I (TnI). The secondary end points were the left ventricular ejection fraction (LVEF) in the hospital and at 9 months follow-up as well as major adverse cardiac events ( MACE: cardiac death, target vessel revascularization, re-infarction ) at 9 months and any bleeding events. Results Baseline characteristics of the two groups were well-balanced. The TIMI 3 flow rate (97.22% vs. 87. 04%, P =0. 011 ) and the complete ST-segment resolution rate (66. 67% vs. 50. 91% ,χ2 =6. 129,P = 0. 047)were significantly higher in the thrombus aspiration + tirofiban group than in the thrombus aspiration group. The peak of CK-MB (83.9 U/L vs. 126. 1 U/L, P = 0. 034) and TnI (42. 7 ng/ml vs. 72.5 ng/ml, P =0. 029) were significantly lower in the thrombus aspiraton + tirofiban group than in the thrombus aspiration group. LVEF in the hospital favored thrombus aspiraton + tirofiban the group (45.7% + 10. 8%, 42. 9%±9.9%, t = 1.99, P =0. 049). There was a tendency to decreased MACE rate at 9-month follow-up,which favored thrombus aspiraton + tirofiban the group ( logrank χ2 = 2. 865, P = 0. 09). Bleeding events were similar between the two groups. Conclusion Thrombus aspiration plus intra-infarct-related artery bolus administration of tirofiban in patients with STEMI undergoing primary angioplasty may improve myocardium perfusion, attenuate myocardial ischemia and result in a better clinical prognosis compared to thrombus aspiration alone.
