CAJ | 학술논문

目的：探讨替罗非班辅助急诊冠状动脉介入（PCI）治疗ST段抬高心肌梗死（STEMI）患者的安全性及近期预后。方法选择2008年12月至2012年6月行急诊PCI治疗的STEMI患者468例，根据是否使用替罗非班，分为替罗非班组（n=351）和对照组（n=117）。采用 Kaplan-Meier和Cox比例风险模型分析两组患者住院期间安全性指标（严重出血、轻微出血、血小板减少症）、术后30天和90天术后主要不良心血管事件（死亡、再梗死、靶血管血运重建）发生情况。结果替罗非班组住院期间安全性指标与对照组相比无统计学差异（P＞0.05）。替罗非班组30天（7.98%vs.16.24%, P=0.01）及90天（8.55%vs.19.66%，P=0.001）主要不良心血管事件（MACE）发生率均低于对照组。Kaplan-Meier生存分析显示，替罗非班组术后30天（Log Rank=7.977，P=0.005）及90天（Log Rank=12.371，P＜0.001）无MACE生存率显著高于对照组。Cox比例风险模型显示替罗非班使用可以减少术后30天（HR=0.443，95%CI：0.247～0793，P=0.006）MACE发生和90天（HR=0.391，95%CI：0.227～0.674，P=0.001）MACE发生的风险。结论替罗非班可改善经直接PCI治疗的STEMI患者短期临床预后，且安全性良好。
목적：탐토체라비반보조급진관상동맥개입（PCI）치료ST단태고심기경사（STEMI）환자적안전성급근기예후。방법선택2008년12월지2012년6월행급진PCI치료적STEMI환자468례，근거시부사용체라비반，분위체라비반조（n=351）화대조조（n=117）。채용 Kaplan-Meier화Cox비례풍험모형분석량조환자주원기간안전성지표（엄중출혈、경미출혈、혈소판감소증）、술후30천화90천술후주요불양심혈관사건（사망、재경사、파혈관혈운중건）발생정황。결과체라비반조주원기간안전성지표여대조조상비무통계학차이（P＞0.05）。체라비반조30천（7.98%vs.16.24%, P=0.01）급90천（8.55%vs.19.66%，P=0.001）주요불양심혈관사건（MACE）발생솔균저우대조조。Kaplan-Meier생존분석현시，체라비반조술후30천（Log Rank=7.977，P=0.005）급90천（Log Rank=12.371，P＜0.001）무MACE생존솔현저고우대조조。Cox비례풍험모형현시체라비반사용가이감소술후30천（HR=0.443，95%CI：0.247～0793，P=0.006）MACE발생화90천（HR=0.391，95%CI：0.227～0.674，P=0.001）MACE발생적풍험。결론체라비반가개선경직접PCI치료적STEMI환자단기림상예후，차안전성량호。
Objective To investigate the safety and short-term prognosis of PCI assisted with tirofiban in the patients with acute ST-segment elevation myocardial infarction (STEMI). Methods The patients (n=468) with emergency PCI were chosen from Dec. 2008 to Jun. 2012, and divided into tirofiban group (n=351) and control group (n=117) according. The safety indexes (severe bleeding, mild bleeding and thrombocytopenia) were analyzed by using Kaplan-Meier and Cox proportional hazard models in the patients during hospitalization. The incidence of major adverse cardiovascular events (MACE, death, reinfarction and target vessel revascularization) was observed respectively 30 d and 90 d after the surgery. Results The safety indexes had no statistical difference between tirofiban group and control group (P>0.05). The incidence of MACE was lower in tirofiban group than that in control group after 30 d (7.98%vs. 16.24%, P=0.01) and 90 d (8.55%vs. 19.66%, P=0.001). The survival analysis of Kaplan-Meier showed that survival rate without MACE was significantly higher in tirofiban group than that in control group after 30 d (Log Rank=7.977, P=0.005) and 90 d (Log Rank=12.371, P<0.001). Cox proportional hazard models showed that tirofiban reduced the incidence of MACE after 30 d (HR=0.443, 95%CI:0.247-0793, P=0.006) and 90 d (HR=0.391, 95%CI:0.227-0.674, P=0.001). Conclusion Tirofiban can improve the short-term prognosis with higher safety in STEMI patients with direct PCI.