Okmen Ertan, Cakmak Mahmut, Tartan Zeynep, Cam Nese
Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Haydarpasa, 81080 Istanbul, Turkey.
Heart Vessels. 2003 Jul;18(3):117-22. doi: 10.1007/s00380-003-0696-x.
Glycoprotein IIb/IIIa receptor inhibition prevents the major cardiac events and improves the prognosis of patients with acute coronary syndromes. The purpose of the study was to evaluate the effects of tirofiban on clinical stabilization parameters in patients with unstable angina (UA) and non-Q-wave myocardial infarction (MI). Eighty-three patients presenting with prolonged ongoing chest pain and ST segment depression were included in the study. Forty-two patients were randomized to aspirin and heparin therapy, and 41 patients to tirofiban therapy in addition to the aspirin and heparin therapy. The interval between the initiation of the treatment and the disappearance of angina, recovery time of ST segment depression, creatine kinase-MB (CK-MB) levels, onset of decrease and normalization of CK-MB, and frequency of in-hospital major cardiac events were compared. The interval between initiation of the treatment and the disappearance of angina was significantly shorter in the tirofiban group (3.5 +/- 4.2 vs 9.1 +/- 8.6 h, P << 0.001). Recovery time of ST depression was also significantly shorter in the tirofiban group (5.1 +/- 7.3 vs 12.3 +/- 11.5 h, P << 0.05). The peak CK-MB values were significantly lower in the non-Q-wave MI and UA subgroups of tirofiban than in the heparin group ( P = 0.04 for both). The onset of the CK-MB decrease was significantly earlier in the tirofiban group (15 +/- 14 vs 24 +/- 15 h, P = 0.02). The normalization time of the CK-MB was relatively shorter in the tirofiban group but without statistical significance (50 +/- 22 vs 60 +/- 25 h). The tirofiban group had a lower frequency of total major cardiac events (26% vs 54%, P = 0.01), acute MI (2.4% vs 19%, P = 0.03), and recurrent angina (26% vs 50%, P = 0.04). The frequency of death and urgent revascularization did not differ between the groups. Tirofiban, in addition to heparin, provides earlier clinical stability and prevents major in-hospital cardiac events in patients with UA and non-Q-wave MI as compared to heparin therapy alone.
糖蛋白IIb/IIIa受体抑制可预防急性冠状动脉综合征患者的主要心脏事件并改善其预后。本研究的目的是评估替罗非班对不稳定型心绞痛（UA）和非Q波心肌梗死（MI）患者临床稳定参数的影响。83例出现持续性胸痛和ST段压低的患者纳入本研究。42例患者随机接受阿司匹林和肝素治疗，41例患者在阿司匹林和肝素治疗基础上接受替罗非班治疗。比较治疗开始至心绞痛消失的时间间隔、ST段压低恢复时间、肌酸激酶同工酶（CK-MB）水平、CK-MB开始下降及恢复正常的时间，以及住院期间主要心脏事件的发生率。替罗非班组治疗开始至心绞痛消失的时间间隔显著缩短（3.5±4.2小时 vs 9.1±8.6小时，P<<0.001）。替罗非班组ST段压低恢复时间也显著缩短（5.1±7.3小时 vs 12.3±11.5小时，P<<0.05）。替罗非班治疗的非Q波MI和UA亚组的CK-MB峰值显著低于肝素组（两者P均=0.04）。替罗非班组CK-MB开始下降的时间显著更早（15±14小时 vs 24±15小时，P = 0.02）。替罗非班组CK-MB恢复正常的时间相对较短，但无统计学意义（50±22小时 vs 60±25小时）。替罗非班组主要心脏事件总发生率较低（26% vs 54%，P = 0.01），急性MI发生率较低（2.4% vs 19%，P = 0.03），复发性心绞痛发生率较低（26% vs 50%，P = 0.04）。两组间死亡和紧急血运重建的发生率无差异。与单独肝素治疗相比，替罗非班联合肝素可使UA和非Q波MI患者更早实现临床稳定，并预防住院期间主要心脏事件。
