Cardiology Department, Ankara University, Ibni Sina Hastanesi, 06600 Ankara, Turkey.
J Thromb Thrombolysis. 2012 Jul;34(1):65-72. doi: 10.1007/s11239-012-0685-y.
We aimed to examine whether intracoronary high-dose bolus of tirofiban plus maintenance would result in improved clinical outcome in STEMI patients undergoing primary PCI in this pilot trial. A total of 56 patients were enrolled to receive either intracoronary high-dose bolus plus maintenance (n = 34) or intravenous high-dose bolus plus maintenance (n = 22) of tirofiban. Pre and post intervention TIMI flow grades, myocardial blush grades, peak CKMB and troponin levels, time to peak CKMB and troponin, time to 50% ST resolution and major composite adverse cardiac event rates at 30 days were recorded. Although incidence of major adverse cardiac events was not different, post intervention TIMI flow and TIMI blush grades, peak CKMB and troponin levels, and time to peak CKMB and time to peak troponin were significantly different, favoring intracoronary strategy. In conclusion, this regimen improved myocardial reperfusion and coronary flow, and reduced myocardial necrosis, but failed to improve clinical outcomes at 30 days.
我们旨在探讨在接受直接经皮冠状动脉介入治疗（PCI）的 ST 段抬高型心肌梗死（STEMI）患者中，冠状动脉内给予大剂量替罗非班推注加维持量是否会改善临床结局。这项试验共纳入了 56 例患者，分别接受冠状动脉内大剂量推注加维持量（n=34）或静脉内大剂量推注加维持量（n=22）替罗非班治疗。记录介入前后 TIMI 血流分级、心肌灌注分级、肌酸激酶同工酶（CKMB）和肌钙蛋白峰值水平、CKMB 和肌钙蛋白达峰时间、50%ST 段回落时间和 30 天主要复合不良心脏事件发生率。尽管主要不良心脏事件发生率无差异，但介入后 TIMI 血流和 TIMI 灌注分级、CKMB 和肌钙蛋白峰值水平以及 CKMB 和肌钙蛋白达峰时间均有显著差异，提示冠状动脉内给药策略更优。总之，该方案改善了心肌再灌注和冠状动脉血流，减少了心肌坏死，但未能改善 30 天的临床结局。
