Yeh Kuo-Ho, Chen Mien-Cheng, Chang Hsueh-Wen, Yu Teng-Hung, Chen Chien-Jen, Chen Yen-Hsun, Chai Han-Tan, Wang Chao-Ping, Hang Chi-Ling, Fu Morgan, Wu Chiung-Jen, Yip Hon-Kan
Division of Cardiology, Chang Gung Memorial Hospital, National Ssun Yat-Sen University, Kaohsiung, Taiwan, ROC.
Jpn Heart J. 2004 Jan;45(1):31-41. doi: 10.1536/jhj.45.31.
The benefit of primary percutaneous coronary intervention is limited by a 5% to 20% incidence of suboptimal epicardial coronary blood (< or = TIMI-2 flow). Recently, data has demonstrated that when administered in conjunction with primary stenting for the treatment of acute myocardial infarction (AMI), abciximab improves the success rate of the stenting procedure and provides additional clinical benefits. But data on a combination of tirofiban and primary stenting for treatment of ST-segment elevated (ST-se) AMI is unknown. Between May 1999 and September 2000, primary stenting without adjunctive tirofiban therapy was performed in 136 consecutive patients (control group) with ST-se AMI. Between January 2001 and May 2002, we routinely administered tirofiban to 133 consecutive patients (study group) with ST-se AMI before they underwent primary stenting. The angiographic and clinical outcomes of both groups were compared in a chronologically consecutive manner. The overall mortality rate was significantly higher in patients with failed (< or = TIMI-2 flow) than in patients with successful (TIMI-3) reperfusion (20.0% vs 3.5%, P < 0.0001). Univariate analysis demonstrated that there were no significant differences in the successful reperfusion (85.7% vs 84.6%, P = 0.84) or 30-day combined end points - death, recurrent ischemia or reinfarction (8.3% vs 11.0%, P = 0.59) between study and control group patients. Clinical variables were used to statistically analyze potential risk factors for unsuccessful reperfusion (< or = TIMI-2 flow) in the study group patients. Multiple stepwise logistic regression analysis demonstrated that the reference lumen diameter (RLD) of the infarct-related artery (IRA) > or = 3.5 mm (P = 0.0004) and the lesion length of the obstruction > or = 20.0 mm (P = 0.018) were the significant independent predictors of failed normalized coronary blood flow. There were no significant differences in the restenotic rate of IRA (29.2% vs 30.8%, P = 0.9) or mortality rate (1.6% vs 1.6%, P = 1.0) at six-month follow-up. In conclusion, our study demonstrates that primary stenting with adjunctive tirofiban therapy in ST-se AMI did not provide additional benefits in short-term and intermediate-term angiographic and clinical outcomes compared to conventional primary stenting.
主要经皮冠状动脉介入治疗的益处受到5%至20%的次优心外膜冠状动脉血流（≤TIMI-2级血流）发生率的限制。最近，数据表明，在与主要支架置入术联合用于治疗急性心肌梗死（AMI）时，阿昔单抗可提高支架置入手术的成功率并带来额外的临床益处。但关于替罗非班与主要支架置入术联合用于治疗ST段抬高型（ST-se）AMI的数据尚不清楚。1999年5月至2000年9月，对136例连续的ST-se AMI患者（对照组）进行了无辅助替罗非班治疗的主要支架置入术。2001年1月至2002年5月，我们在133例连续的ST-se AMI患者（研究组）进行主要支架置入术前常规给予替罗非班。以时间顺序连续的方式比较了两组的血管造影和临床结果。再灌注失败（≤TIMI-2级血流）的患者的总死亡率显著高于再灌注成功（TIMI-3级）的患者（20.0%对3.5%，P<0.0001）。单因素分析表明，研究组和对照组患者在成功再灌注（85.7%对84.6%，P=0.84）或30天联合终点——死亡、再发缺血或再梗死（8.3%对11.0%，P=0.59）方面无显著差异。使用临床变量对研究组患者再灌注失败（≤TIMI-2级血流）的潜在危险因素进行统计分析。多因素逐步逻辑回归分析表明，梗死相关动脉（IRA）的参考管腔直径（RLD）≥3.5 mm（P=0.0004）和阻塞病变长度≥20.0 mm（P=0.018）是冠状动脉血流正常化失败的显著独立预测因素。在六个月随访时，IRA的再狭窄率（29.2%对30.8%，P=0.9）或死亡率（1.6%对1.6%，P=1.0）无显著差异。总之，我们的研究表明，与传统主要支架置入术相比，在ST-se AMI中采用辅助替罗非班治疗的主要支架置入术在短期和中期血管造影及临床结果方面未提供额外益处。
