Zhang You, Gao Chuanyu, Liu Hongzhi, Wang Xianpei, Yang Honghui, Li Muwei, Wang Xianqing, Zhu Zhongyu, Hu Dayi
Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, China.
Clin Exp Pharmacol Physiol. 2013 Apr;40(4):289-94. doi: 10.1111/1440-1681.12065.
The present study examined the optimal timing of tirofiban administration in moderate- or high-risk non-ST segment elevated acute coronary syndrome (NSTE-ACS) patients undergoing percutaneous coronary intervention (PCI). Eligible patients were randomized into two groups. Tirofiban was administered routinely at ≥ 4 h before angiography (routine early group; n = 141 patients) or provisionally only for bailout after angiography (deferred provisional group; n = 145 patients). The parameters analysed were: creatine kinase MB isoenzyme (CK-MB), thrombolysis in myocardial infarction (TIMI) flow, thrombotic complications during PCI, efficacy end-points (death, myocardial infarction or target vessel revascularization) at 7, 30 and 180 days and safety end-points (bleeding or thrombocytopenia). In the deferred provisional group, 48 patients (33.1%) required bailout tirofiban. Tirofiban was administered 5.8 h earlier in the routine early compared with the deferred provisional group. The routine early group showed a lower percentage increase in CK-MB (in U/L) 12-24 h after PCI compared with the deferred provisional group (0 (-4.0, 3.0) vs 0.4 (-3.0, 5.0), respectively; P = 0.045), as well as higher pre-PCI TIMI 3 (i.e. normal) flow (78.7% vs 64.8%, respectively; P = 0.042) and a lower incidence of thrombotic events (5.0% vs 33.1%, respectively; P < 0.0001). There were no significant differences in efficacy and safety end-points. In patients with moderate- or high-risk NSTE-ACS, early tirofiban combined with dual antiplatelet therapy was associated with better patency before PCI, attenuated minor myocardial damage and a lower prevalence of thrombotic complications during PCI, but had no significant benefit on the post-PCI TIMI 3 flow or short-term prognosis.
本研究探讨了替罗非班在接受经皮冠状动脉介入治疗（PCI）的中高危非ST段抬高型急性冠状动脉综合征（NSTE-ACS）患者中的最佳给药时机。符合条件的患者被随机分为两组。替罗非班在血管造影前≥4小时常规给药（常规早期组；n = 141例患者），或仅在血管造影后用于补救（延迟临时组；n = 145例患者）。分析的参数包括：肌酸激酶MB同工酶（CK-MB）、心肌梗死溶栓（TIMI）血流、PCI期间的血栓并发症、7天、30天和180天的疗效终点（死亡、心肌梗死或靶血管血运重建）以及安全终点（出血或血小板减少）。在延迟临时组中，48例患者（33.1%）需要补救性使用替罗非班。与延迟临时组相比，常规早期组替罗非班给药时间提前5.8小时。与延迟临时组相比，常规早期组在PCI后12 - 24小时CK-MB（单位：U/L）的升高百分比更低（分别为0（-4.0，3.0）与0.4（-3.0，5.0）；P = 0.045），PCI前TIMI 3级（即正常）血流更高（分别为78.7%与64.8%；P = 0.042），血栓事件发生率更低（分别为5.0%与33.1%；P < 0.0001）。疗效和安全终点方面无显著差异。在中高危NSTE-ACS患者中，早期使用替罗非班联合双联抗血小板治疗与PCI前更好的血管通畅、减轻轻微心肌损伤以及PCI期间血栓并发症发生率较低相关，但对PCI后TIMI 3级血流或短期预后无显著益处。
