Department of Cardiology, Medisch Centrum Alkmaar, Alkmaar, the Netherlands.
J Thromb Haemost. 2009 Oct;7(10):1612-8. doi: 10.1111/j.1538-7836.2009.03573.x. Epub 2009 Aug 11.
No randomized comparisons are yet available evaluating the effect of pre-hospital high dose tirofiban on the incidence of early stent thrombosis after primary percutaneous coronary intervention (PCI).
The aim of this analysis was to evaluate whether routine pre-hospital administration of high-dose tirofiban in ST-segment elevation myocardial infarction (STEMI) decreases the incidence of early stent thrombosis after primary PCI.
PATIENTS/METHODS: The Ongoing Tirofiban in Myocardial Evaluation (On-TIME) 2 trial was a prospective multicenter study of consecutive STEMI patients referred for primary PCI in which patients were randomized to pre-hospital no high-dose tirofiban/placebo. We examined the incidence of Academic Research Consortium definite and probable early stent thrombosis and determined predictors and outcome of early stent thrombosis.
Primary PCI was performed in 1203 out of 1398 patients (86.1%). In 1073 patients (89.2%) a coronary stent was placed. Early stent thrombosis occurred in 39 patients (3.6%). Pre-hospital initiation of high-dose tirofiban significantly reduced early stent thrombosis (2.1% vs. 5.2%, P = 0.006) and was associated with a lower incidence of urgent repeat PCI (1.9% vs. 5.2%, P = 0.005). Early stent thrombosis, as well as pre-hospital initiation of high-dose tirofiban, was independently associated with 30-day mortality.
Pre-hospital initiation of high-dose tirofiban reduces the 30-day incidence of stent thrombosis in STEMI patients treated with primary PCI and stenting. Early stent thrombosis and pre-hospital initiation of high-dose tirofiban were independent predictors of 30-day mortality.
目前尚无随机对照研究评估院前应用高剂量替罗非班对直接经皮冠状动脉介入治疗（PCI）后早期支架血栓形成的影响。
本分析旨在评估 ST 段抬高型心肌梗死（STEMI）患者院前常规应用高剂量替罗非班是否降低直接 PCI 后早期支架血栓形成的发生率。
患者/方法：正在进行的心肌评估中的替罗非班（On-TIME 2）试验是一项连续 STEMI 患者接受直接 PCI 的前瞻性多中心研究，患者被随机分为院前无高剂量替罗非班/安慰剂组。我们检查了学术研究联合会（ARC）明确和可能的早期支架血栓形成的发生率，并确定了早期支架血栓形成的预测因素和结果。
1398 例患者中 1203 例（86.1%）接受了直接 PCI。1073 例患者（89.2%）置入了冠状动脉支架。39 例患者（3.6%）发生了早期支架血栓形成。院前应用高剂量替罗非班显著降低了早期支架血栓形成的发生率（2.1%比 5.2%，P=0.006），并与紧急重复 PCI 的发生率降低相关（1.9%比 5.2%，P=0.005）。早期支架血栓形成和院前应用高剂量替罗非班均与 30 天死亡率独立相关。
在接受直接 PCI 和支架置入术的 STEMI 患者中，院前应用高剂量替罗非班可降低 30 天支架血栓形成的发生率。早期支架血栓形成和院前应用高剂量替罗非班是 30 天死亡率的独立预测因素。
