血栓抽吸后联合药物注入在急性ST段抬高型心肌梗死患者急诊冠状动脉介入治疗中的应用
作者:
作者单位:

(深圳市孙逸仙心血管医院心内科,广东省深圳市 518020)

作者简介:

刘强,主任医师,研究方向为冠心病的介入治疗,E-mail为13802263916@139.com。左辉华,硕士,副主任医师,研究方向为冠心病的基础与临床。王丽丽,硕士,主任医师,研究方向为心内科疾病的诊疗。

基金项目:

广东省科技计划项目(2012B031800021)


Intracoronary Tirofiban and Verapamil Injection After Thrombus Aspiration During Emergency Percutaneous Coronary Intervention
Author:
Affiliation:

Department of Cardiology, Shenzhen Sun Yat-sen Cardiovascular Hospital, Shenzhen, Guangdong 518020, China)

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    摘要:

    目的 研究急诊冠状动脉介入治疗中血栓抽吸后联合替罗非班及维拉帕米冠状动脉内注射对急性ST段抬高型心肌梗死患者心肌灌注及预后的影响。方法 纳入281例急性ST段抬高型心肌梗死拟行急诊PCI治疗患者,分为联合药物治疗组(即在常规对闭塞血管行血栓抽吸后即刻通过抽吸导管于闭塞处以远注入替罗非班及维拉帕米药物,其后再行球囊扩张或支架术)及对照组(对闭塞血管行血栓抽吸及球囊扩张后置入支架),术后进行为期6个月的随访,比较两组术后即刻冠状动脉血流及心肌灌注情况,半年内主要心脏不良事件(MACE)发生率及随访半年内左心室收缩功能。结果 两组间入选时基本临床资料比较差异无显著性;两组间术后TIMI3级血流患者比例无明显差异(91.5%比89.3%,P=0.531);联合药物治疗组较对照组有更低的校正的TIMI血流帧数计数(CTFC)(21±6比25±8,P<0.001),心肌灌注分级(TMPG)2~3级比例高于对照组(65.2%比52.1%,P<0.001)。联合药物治疗组术后2 h心电图ST段回落>50%患者比例高于对照组(66.7%比53.6%,P=0.025);两组患者术后半年内MACE发生率无明显差异(2.1%比3.6%,P=0.712)。联合药物治疗组半年后左心室射血分数(LVEF)值较对照组升高(50%±8%比46%±9%,P<0.001),左心室舒张期末内径(LVEDd)值较对照组减小(47.6%±8.3%比52.6%±7.7%,P<0.001)。结论 急诊冠状动脉介入治疗术中血栓抽吸后于冠状动脉内注射替罗非班及维拉帕米能改善急性心肌梗死患者心肌水平的灌注,提高了左心室收缩功能,可能对改善患者的长期预后有一定的帮助。

    Abstract:

    Aim To evaluate the myocardial level perfusion and clinical outcomes at 6 months of the acute myocardial infarction patients after thrombus aspiration combined with tirofiban and verapamil injection via aspiration catheter compared with thrombus aspiration alone. Methods A total of 281 consecutive patients with acute ST elevation myocardial infarction(STEMI) , who underwent primary percutaneous coronary intervention (PCI) within 24 hours of onset, were assigned to two groups:Group A, intracoronary administration(IC) of a fixed dose of verapamil (200 μg) plus tirofiban (10 μg/kg) after thrombus aspiration and group B, IC administration of heparinized saline 5 mL after thrombus aspiration (n=141 and n=140, respectively). The drugs were selectively injected into the infarct-related artery (IRA) via a thrombus aspiration catheter. The primary end-point was post-procedural corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC). The proportion of complete (>50%) ST-segment resolution (STR), the TIMI myocardial perfusion grade (TMPG) 2-3 ratio following PCI, the TIMI flow grade, the incidence of major adverse cardiac events (MACE), the left ventricular ejection fraction (LVEF), the left ventricular end-diastolic diameter (LVEDd) after 6 months of follow-up were observed as the secondary end-points. Results There were no significant differences in the baseline clinical and angiographic characteristics between the two groups. Compared with group B, group A had a lower CTFC (21±6 vs 25±8, P<0.001), a higher proportion of complete STR (66.7% vs 53.6%, P=0.025), an enhanced TMPG 2-3 ratio (65.2% vs 52.1%, P<0.001). There was no statistically significant difference in the final TIMI grade-3 flow between the two groups (91.5 vs 89.3%, P=0.531). The LVEF at 6 months in group A was higher than group B (50±8% vs 46±9%, P<0.001),and the LVEDd in group A was lower than group B (47.6±8.3% vs 52.6±7.7%, P<0.001). However, the incidence of MACE had no statistically difference between the two groups(2.1% vs 3.6%, P=0.712). Conclusions The selective IC administration of a fixed dose of verapamil (200 μg) plus tirofiban via a thrombus aspiration catheter advanced into the IRA after thrombus aspiration is a safe and superior treatment method compared with thrombus aspiration alone in patients with STEMI undergoing primary PCI. This novel therapeutic strategy improves the myocardial level perfusion, in addition to improving heart function. Furthermore, it may improve the postoperative clinical prognosis following PCI.

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刘强,左辉华,王丽丽,罗新林,翁建新,陈绮映,曹茜,魏熠.血栓抽吸后联合药物注入在急性ST段抬高型心肌梗死患者急诊冠状动脉介入治疗中的应用[J].中国动脉硬化杂志,2016,24(4):386~390.

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  • 收稿日期:2015-10-27
  • 最后修改日期:2016-01-28
  • 在线发布日期: 2016-06-30