van 't Hof Arnoud W J, Ernst Nicolette, de Boer Menko-Jan, de Winter Rob, Boersma Eric, Bunt Ton, Petronio Sonia, Marcel Gosselink A T, Jap Walter, Hollak Frans, Hoorntje Jan C A, Suryapranata Harry, Dambrink Jan-Henk E, Zijlstra Felix
Isala Klinieken, Locatie Weezenlanden, Department of Cardiology, Groot Wezenland 20, 8011 JW Zwolle, The Netherlands.
Eur Heart J. 2004 May;25(10):837-46. doi: 10.1016/j.ehj.2004.04.003.
Although primary angioplasty is effective despite additional transportation delay, improved patency before PCI might be obtained by starting pharmacological pre-treatment before transportation.
From June 2001 to November 2002, 507 patients with acute myocardial infarction, who were transferred to a PCI centre, were randomised to early, pre-hospital initiation of Tirofiban (Early) or to initiation in the catheterisation laboratory (Late). The primary end-point was TIMI flow grade 3 of the infarct-related vessel (IRV) at initial angiography, as assessed by an independent core-lab. The effect of Tirofiban on each TIMI flow component, the presence of thrombus at initial angiography and pre-PCI myocardial blush grade were secondary end-points. A large proportion of patients (41%) was diagnosed and randomised in the ambulance, without intervention of a physician. In the Early group, Tirofiban was administered a median of 59 min (range 11-178 min) earlier than in the Late group. At initial angiography, TIMI 3 flow was present in 19% the Early group and in 15% in the Late group (P = 0.22). The combined incidence of TIMI 2 or 3 flow was present in 43% in the Early group and in 34% in the Late group, respectively (P = 0.04). Thrombus or a fresh occlusion was present in 60% and 73% in the Early and Late group, respectively (P = 0.002). A pre-PCI myocardial blush grades 2 or 3 was more often present in the Early group (30% vs. 22%, P = 0.04). However, no difference in TIMI 3 flow or myocardial blush grade was found between the groups, post-PCI. At one-year follow-up, the combined incidence of death or recurrent MI was not different between the groups (7.0% vs. 7.0%, P = 0.99).
Early initiation of Tirofiban did not improve initial TIMI 3 flow of the IRV significantly. Despite a better patency (TIMI 2 or 3 flow), a lower prevalence of thrombus or fresh occlusion and a better myocardial perfusion in the infarct-related region pre-PCI, no beneficial effect on post-PCI angiographic or clinical outcome was found, as compared to initiation of Tirofiban in the catheterisation laboratory.
尽管存在额外转运延迟，直接血管成形术仍有效，但在转运前开始药物预处理可能会改善PCI前的血管通畅情况。
2001年6月至2002年11月，507例急性心肌梗死患者被转至PCI中心，随机分为替罗非班早期（院前）启动组（早期组）或导管室启动组（晚期组）。主要终点是由独立核心实验室评估的初始血管造影时梗死相关血管（IRV）的TIMI血流3级。替罗非班对每个TIMI血流成分的影响、初始血管造影时血栓的存在情况以及PCI前心肌造影剂增强分级为次要终点。很大一部分患者（41%）在救护车上被诊断并随机分组，未经过医生干预。早期组替罗非班给药时间比晚期组中位数早59分钟（范围11 - 178分钟）。初始血管造影时，早期组19%出现TIMI 3级血流，晚期组为15%（P = 0.22）。早期组和晚期组TIMI 2级或3级血流的合并发生率分别为43%和34%（P = 0.04）。早期组和晚期组分别有60%和73%存在血栓或新鲜闭塞（P = 0.002）。PCI前心肌造影剂增强分级为2级或3级在早期组更常见（30%对22%，P = 0.0年随访时，两组死亡或复发性心肌梗死的合并发生率无差异（7.0%对7.0%，P = 0.99）。
早期启动替罗非班并未显著改善IRV的初始TIMI 3级血流。尽管PCI前血管通畅情况更好（TIMI 2级或3级血流）、血栓或新鲜闭塞的发生率更低且梗死相关区域心肌灌注更好，但与在导管室启动替罗非班相比，未发现对PCI后血管造影或临床结局有有益影响。 04）。PCI后，两组之间TIMI 3级血流或心肌造影剂增强分级无差异。1
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