Department of Cardiology, Faculty of Medicine, Atatürk University, Erzurum, Turkey,
Adv Ther. 2013 Sep;30(9):834-44. doi: 10.1007/s12325-013-0055-y. Epub 2013 Sep 21.
Percutaneous coronary intervention (PCI) does not often produce optimal results, despite restoration of coronary blood flow at myocardial recovery, because of impaired microvascular perfusion. This study aimed to investigate and evaluate with (99m)Tc-sestamibi scan whether the results of PCI can be changed by maintenance infusion of tirofiban for 24 or 48 h in patients presenting with anterior ST-elevation myocardial infarction (STEMI).
The study included 84 patients with anterior STEMI who were candidates for primary PCI and whose occlusion was in the proximal or mid-left anterior descending artery. Patients were given 25 μg/kg/3 min tirofiban and randomized to receive maintenance infusion at 0.15 μg/kg/min for 24 or 48 h. A resting (99m)Tc sestamibi scan was performed on the 5th day post-procedure before discharge. The primary efficacy endpoint was a patient's score on a 5-point scoring system for perfusion defect severity. Major adverse cardiac events (MACE) were defined as death from any cause, re-infarction, and clinically driven target-vessel revascularization within the first 6 months.
Baseline characteristics of the patients were similar in the two infusion groups (n = 42 per group). There was no significant difference in the symptom onset-to-presentation time or door-to-balloon time between the two groups. With the exception of basal anteroseptal and basal anterior segments, significant reductions were obtained on the 5-point scoring system for perfusion defect severity in segments and in the summed rest scores. No significant differences were observed between the two groups in the incidence of MACE at 6 months. The safety profile did not differ between 24 and 48 h infusions of tirofiban.
The use of tirofiban, when administered at a high bolus dose and maintained for 48 h, was safe and significantly reduced perfusion defect severity in patients with anterior STEMI presenting early after symptom onset and undergoing primary PCI.
尽管在心肌恢复时恢复了冠状动脉血流，但经皮冠状动脉介入治疗（PCI）通常并不能产生理想的结果，因为微血管灌注受损。本研究旨在通过（99m）Tc-sestamibi 扫描，观察替罗非班维持输注 24 或 48 小时对前壁 ST 段抬高型心肌梗死（STEMI）患者 PCI 结果的影响。
该研究纳入了 84 例前壁 STEMI 患者，这些患者为直接 PCI 候选者，且其闭塞部位位于左前降支近端或中段。患者接受 25μg/kg/3min 的替罗非班负荷量，随后随机接受 0.15μg/kg/min 的替罗非班维持输注，输注时间为 24 或 48 小时。患者于术后第 5 天（出院前）行静息（99m）Tc sestamibi 扫描。主要疗效终点为患者灌注缺损严重程度的 5 分评分系统评分。主要不良心脏事件（MACE）定义为任何原因导致的死亡、再梗死和 6 个月内的临床驱动的靶血管血运重建。
两组患者的基线特征相似（每组 n=42）。两组间症状发作至就诊时间或门球时间无显著差异。除了基底前间隔和基底前壁节段外，灌注缺损严重程度的 5 分评分系统、节段和总和静息评分均有显著降低。两组患者在 6 个月时的 MACE 发生率无显著差异。替罗非班输注 24 或 48 小时的安全性无差异。
在早期症状发作和接受直接 PCI 的前壁 STEMI 患者中，高负荷剂量替罗非班给药并维持 48 小时是安全的，可显著降低灌注缺损严重程度。
