Emre Ayse, Ucer Ekrem, Yesilcimen Kemal, Bilsel Tuba, Oz Dilaver, Sayar Nurten, Terzi Sait, Akbulut Tamer, Ersek Birsen
Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey.
Cardiology. 2006;106(4):264-9. doi: 10.1159/000093408. Epub 2006 May 22.
BACKGROUND/AIMS: The timing of GpIIb/IIIa inhibitor administration may be important in achieving early epicardial and myocardial reperfusion. We evaluated the effect of early tirofiban on myocardial salvage and cardiovascular outcome in patients with acute myocardial infarction (AMI) undergoing infarct-related artery stenting.
Patients (n = 66) with a first AMI presenting <6 h from onset of symptoms were randomized to either early administration of tirofiban in the emergency room (n = 32) or later administration in the catheterization laboratory (n = 34) (tirofiban bolus dose of 10 microg/kg, followed by 0.15 microg/kg for 24 h). The primary end-point was the degree of myocardial salvage, determined by means of serial scintigraphic studies with technetium-99m sestamibi. Thirty-day major adverse cardiac events were also assessed.
There were no significant differences in patient characteristics or in their presentation. The mean door-to-balloon time was similar in both groups (43 +/- 12 and 53 +/- 9 min, p = 0.08). The early and late treatment groups received tirofiban 18 +/- 4 and 52 +/- 10 min after admission, respectively. Angiographic analysis revealed a higher initial frequency of TIMI grade 3 flow in the early group (31% vs. 12%, p = 0.04). Procedural success was achieved in all patients. Myocardial risk area were comparable between early and late treatment groups (35.6 +/- 12.2% vs. 39.3 +/- 14.0%, p = 0.6). Scintigraphic outcomes demonstrated a significant reduction in the final infarction size (11.8 +/- 5.2% vs. 22.4 +/- 6.2%, p = 0.01), and improvement in salvage index (0.68 +/- 0.22 vs. 0.44 +/- 0.18, p = 0.003) in favor of the early tirofiban group. The thirty-day composite end-point of death, recurrent MI or rehospitalization also favored the early group (6% early, 15% late, p = 0.06).
Early tirofiban administration enhanced the degree of myocardial salvage and clinical outcome in patients with AMI undergoing infarct-related artery stenting.
背景/目的：给予糖蛋白IIb/IIIa抑制剂的时机对于实现早期心外膜和心肌再灌注可能至关重要。我们评估了早期替罗非班对急性心肌梗死（AMI）患者行梗死相关动脉支架置入术时心肌挽救及心血管结局的影响。
症状发作后<6小时出现首次AMI的患者（n = 66）被随机分为在急诊室早期给予替罗非班组（n = 32）或在导管室延迟给予替罗非班组（n = 34）（替罗非班推注剂量为10μg/kg，随后以0.15μg/kg持续输注24小时）。主要终点是心肌挽救程度，通过用锝-99m甲氧基异丁基异腈进行系列闪烁扫描研究来确定。还评估了30天主要不良心脏事件。
患者特征或表现无显著差异。两组的平均门球时间相似（43±12和53±9分钟，p = 0.08）。早期和晚期治疗组分别在入院后18±4和52±10分钟接受替罗非班治疗。血管造影分析显示早期组TIMI 3级血流的初始频率更高（31%对12%，p = 0.04）。所有患者均获得手术成功。早期和晚期治疗组之间的心肌危险区域相当（35.6±12.2%对39.3±14.0%，p = 0.6）。闪烁扫描结果显示最终梗死面积显著减小（11.8±5.2%对22.4±6.2%，p = 0.01），挽救指数改善（0.68±0.22对0.44±0.18，p = 0.003），有利于早期替罗非班组。30天死亡、再发心肌梗死或再次住院的复合终点也有利于早期组（早期6%，晚期15%，p = 0.06）。
对于行梗死相关动脉支架置入术的AMI患者，早期给予替罗非班可提高心肌挽救程度及临床结局。
