Chen Yi, Zhou Peng, Yan Hongbing, Zhao Hanjun, Song Li, Liu Chen, Zhao Bo, Chi Yunpeng, Wang Shaoping, Wang Jian
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
J Invasive Cardiol. 2013 Aug;25(8):376-82.
It is unclear whether selective infarct-related artery (sIRA) administration of glycoprotein IIb/IIIa receptor inhibitors (GPI) may further improve myocardial reperfusion without increasing bleeding in patients with ST-elevation myocardial infarction (STEMI). The aim of this study was to compare the impacts of sIRA infusion with conventional intracoronary (IC) administration of GPI tirofiban on myocardial reperfusion and clinical prognosis in STEMI patients.
A total of 203 consecutive STEMI patients within 12 hours of symptom onset were randomly assigned to receive tirofiban (10 μg/kg body weight) through aspiration catheter (n = 107) or guiding catheter (n = 96) after thrombus aspiration, and following 12 hours of intravenous infusion (0.1 μg/kg/min). The primary endpoint was the corrected Thrombolysis in Myocardial Infarction (TIMI) frame count (CTFC) after the procedure. The secondary endpoint was major adverse cardiac events at 30 days and 6 months. The safety endpoint was in-hospital bleeding, defined according to the TIMI bleeding classification.
Similar primary endpoints (CTFC of 28 ± 17 vs 27 ± 15; P=.841) were observed in the sIRA and conventional IC administration groups, respectively. The incidence of major adverse cardiac events (6.5% vs 5.2% at 30 days [P=.688] and 8.4% vs 7.3% at 6 months [P=.762]) and in-hospital major or minor bleeding (9.3% vs 8.3%; P=.800) were comparable in both groups.
After thrombus aspiration, sIRA infusion of tirofiban does not improve myocardial reperfusion assessed by CTFC, as well as ischemic or bleeding events in this study.
对于ST段抬高型心肌梗死（STEMI）患者，梗死相关动脉（sIRA）选择性给予糖蛋白IIb/IIIa受体抑制剂（GPI）是否能在不增加出血风险的情况下进一步改善心肌再灌注尚不清楚。本研究旨在比较sIRA输注与常规冠状动脉内（IC）给予GPI替罗非班对STEMI患者心肌再灌注及临床预后的影响。
共纳入203例症状发作12小时内的连续STEMI患者，随机分为两组，在血栓抽吸后，通过抽吸导管（n = 107）或引导导管（n = 96）给予替罗非班（10μg/kg体重），随后静脉输注12小时（0.1μg/kg/min）。主要终点为术后校正的心肌梗死溶栓（TIMI）帧数（CTFC）。次要终点为30天和6个月时的主要不良心脏事件。安全终点为根据TIMI出血分类定义的院内出血。
sIRA组和常规IC给药组分别观察到相似的主要终点（CTFC分别为28±17和27±15；P = 0.841）。两组的主要不良心脏事件发生率（30天时分别为6.5%和5.2%[P = 0.688]，6个月时分别为8.4%和7.3%[P = 0.762]）以及院内主要或轻微出血发生率（9.3%和8.3%；P = 0.800）相当。
在本研究中，血栓抽吸后，sIRA输注替罗非班并不能改善通过CTFC评估的心肌再灌注以及缺血或出血事件。
