Zhang Dapeng, Wang Lefeng, Du Jinquan, Wang Hongshi, Xu Li, Li Weiming, Ni Zhuhua, Xia Kun, Liu Yu, Yang Xinchun
Heart Center, Beijing Chaoyang Hospital affiliated to Capital Medical University,Beijing 100020, China.
Heart Center, Beijing Chaoyang Hospital affiliated to Capital Medical University,Beijing 100020, China. Email:
Zhonghua Xin Xue Guan Bing Za Zhi. 2014 Jan;42(1):25-30.
To explore the impact of intracoronary bolus administration of tirofiban combined with nitroprusside through thrombus aspiration catheter or thrombus aspiration alone on myocardial reperfusion and major adverse cardiovascular events rate in acute anterior myocardial infarction patients with heavy thrombosis burden.
Ninety consecutive acute anterior myocardial infarction patients with heavy thrombosis burden [(59.8 ± 11.5) years old] were randomly assigned to thrombus aspiration group (Group A, n = 30), thrombus aspiration and intracoronary tirofiban bolus (25 µg/kg prior to the first balloon inflation,Group B, n = 30), thrombus aspiration and intracoronary tirofiban combined with nitroprusside bolus (200 µg prior to the first balloon inflation, Group C, n = 30) with random number table. Baseline clinical data, angiographic features before and after percutaneous coronary intervention (PCI) and major adverse cardiovascular events after PCI between 3 groups were compared.
The baseline clinical data and angiographic features among 3 groups were similar (all P > 0.05) . The time of pain to balloon was (5.5 ± 3.8) hours. After primary PCI, myocardial tissue perfusion was significantly better in Group C than in Group A and Group B: TMP grade < 3 [10.0% (3/30) vs. 40.0% (12/30) and 33.3% (10/30), P < 0.01 and P < 0.05]. Left ventricular ejection fraction at 5 to 7 days after PCI also tended higher in Group C than in the other 2 groups (P = 0.05). One patient died of heart failure at 7th day after PCI in Group A, and no patient died in Group B and C. Thirty days after PCI, there was no re-myocardial infarction and target vessel revascularization event among 3 groups. The bleeding complication rate during 30 days follow-up was similar among 3 groups (P > 0.05) .
Intracoronary bolus application of tirofiban combined with nitroprusside through thrombus aspiration catheter after thrombus aspiration is associated with an improvement of myocardial reperfusion without increasing bleeding complication and other adverse cardiovascular events rate compared with thrombus aspiration alone in patients with acute anterior myocardial infarction and heavy thrombosis burden undergoing primary PCI.
探讨通过血栓抽吸导管冠状动脉内推注替罗非班联合硝普钠或单纯血栓抽吸对血栓负荷重的急性前壁心肌梗死患者心肌再灌注及主要不良心血管事件发生率的影响。
将90例连续入选的血栓负荷重的急性前壁心肌梗死患者[年龄(59.8±11.5)岁]，采用随机数字表法随机分为血栓抽吸组(A组，n = 30)、血栓抽吸联合冠状动脉内推注替罗非班组(首次球囊扩张前推注25 μg/kg，B组，n = 30)、血栓抽吸联合冠状动脉内推注替罗非班及硝普钠组(首次球囊扩张前推注200 μg，C组，n = 30)。比较3组患者的基线临床资料、经皮冠状动脉介入治疗(PCI)前后的血管造影特征及PCI术后主要不良心血管事件。
3组患者的基线临床资料和血管造影特征相似(均P>0.05)。疼痛至球囊扩张时间为(5.5±3.8)小时。直接PCI术后，C组心肌组织灌注明显优于A组和B组：心肌灌注分级(TMP)<3级的比例[10.0%(3/30)比40.0%(12/30)和33.3%(10/30)，P<0.01和P<0.05]。PCI术后5~7天C组左心室射血分数也高于其他2组(P = 0.05)。A组1例患者在PCI术后第7天死于心力衰竭，B组和C组无患者死亡。PCI术后30天，3组均无再发心肌梗死及靶血管血运重建事件。3组30天随访期间出血并发症发生率相似(P>0.05)。
对于接受直接PCI的血栓负荷重的急性前壁心肌梗死患者，血栓抽吸后通过血栓抽吸导管冠状动脉内推注替罗非班联合硝普钠与单纯血栓抽吸相比，可改善心肌再灌注，且不增加出血并发症及其他不良心血管事件发生率。
