Li Shi-ying, Yan Hong-bing, Wang Jian, Song Li, Wu Zheng, Chi Yun-peng, Zheng Bin, Zhao Han-jun, Li Qing-xiang, Zhang Xiao-jiang, Li Wen-zheng, Liu Chen
Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2010 Oct;38(10):880-5.
To investigate whether thrombus aspiration plus intra-infarct-related artery bolus administration of tirofiban via the aspiration catheter is superior to thrombus aspiration alone in improving myocardial perfusion in patients with ST-elevation myocardial infarction (STEMI) undergoing primary angioplasty.
In this single center retrospective study, 108 patients with STEMI who underwent angioplasty after thrombus aspiration plus intra-infarction related artery 500 µg tirofiban administration, with subsequent 12-hour intravenous infusion of 0.1 µg×kg(-1)×min(-1) after angioplasty (thrombus aspiration + tirofiban group) and 108 matched control patients with STEMI who underwent angioplasty after thrombus aspiration (thrombus aspiration group). The primary end points included thrombolysis in myocardial infarction (TIMI) flow immediately after angioplasty, complete ST-segment elevation resolution (> 70%) at 90 minutes after angioplasty and the peak of creatine kinase-MB (CK-MB) and troponin I (TnI). The secondary end points were the left ventricular ejection fraction (LVEF) in the hospital and at 9 months follow-up as well as major adverse cardiac events (MACE: cardiac death, target vessel revascularization, re-infarction) at 9 months and any bleeding events.
Baseline characteristics of the two groups were well-balanced. The TIMI 3 flow rate (97.22% vs. 87.04%, P = 0.011) and the complete ST-segment resolution rate (66.67% vs. 50.91%, χ(2) = 6.129, P = 0.047)were significantly higher in the thrombus aspiration + tirofiban group than in the thrombus aspiration group. The peak of CK-MB (83.9 U/L vs. 126.1 U/L, P = 0.034) and TnI (42.7 ng/ml vs. 72.5 ng/ml, P = 0.029) were significantly lower in the thrombus aspiration + tirofiban group than in the thrombus aspiration group. LVEF in the hospital favored thrombus aspiration + tirofiban the group (45.7% ± 10.8%, 42.9% ± 9.9%, t = 1.99, P = 0.049). There was a tendency to decreased MACE rate at 9-month follow-up, which favored thrombus aspiration + tirofiban the group (logrank χ(2) = 2.865, P = 0.09). Bleeding events were similar between the two groups.
Thrombus aspiration plus intra-infarct-related artery bolus administration of tirofiban in patients with STEMI undergoing primary angioplasty may improve myocardium perfusion, attenuate myocardial ischemia and result in a better clinical prognosis compared to thrombus aspiration alone.
探讨在接受直接血管成形术的ST段抬高型心肌梗死（STEMI）患者中，血栓抽吸联合经抽吸导管在梗死相关动脉内推注替罗非班是否优于单纯血栓抽吸，以改善心肌灌注。
在这项单中心回顾性研究中，108例STEMI患者在血栓抽吸后于梗死相关动脉内给予500μg替罗非班，随后在血管成形术后静脉输注0.1μg×kg⁻¹×min⁻¹持续12小时（血栓抽吸+替罗非班组），以及108例匹配的接受血栓抽吸后行血管成形术的STEMI对照患者（血栓抽吸组）。主要终点包括血管成形术后即刻心肌梗死溶栓（TIMI）血流、血管成形术后90分钟时ST段抬高完全缓解（>70%）以及肌酸激酶-MB（CK-MB）和肌钙蛋白I（TnI）峰值。次要终点为住院时及9个月随访时的左心室射血分数（LVEF）以及9个月时的主要不良心脏事件（MACE：心源性死亡、靶血管血运重建、再梗死）和任何出血事件。
两组的基线特征均衡。血栓抽吸+替罗非班组的TIMI 3级血流率（97.22%对87.04%，P = 0.011）和ST段完全缓解率（66.67%对50.91%，χ² = 6.129，P = 0.047）显著高于血栓抽吸组。血栓抽吸+替罗非班组的CK-MB峰值（83.9 U/L对126.1 U/L，P = 0.034）和TnI峰值（42.7 ng/ml对72.5 ng/ml，P = 0.029）显著低于血栓抽吸组。住院时的LVEF有利于血栓抽吸+替罗非班组（45.7%±10.8%，42.9%±9.9%，t = 1.99，P = 0.049）。9个月随访时MACE率有下降趋势，有利于血栓抽吸+替罗非班组（对数秩χ² = 2.865，P = 0.09）。两组间出血事件相似。
在接受直接血管成形术的STEMI患者中，血栓抽吸联合在梗死相关动脉内推注替罗非班可能比单纯血栓抽吸更能改善心肌灌注、减轻心肌缺血并带来更好的临床预后。
