在直接经皮冠状动脉介入治疗期间，经灌注导管局部冠状动脉内输注糖蛋白IIb/IIIa抑制剂与经冠状动脉引导导管注射的比较：一项初步观察性研究。
Local Intracoronary Infusion of Glycoprotein IIb/IIIa Inhibitors via a Perfusion Catheter versus Intracoronary Guiding Catheter Injection during Primary Percutaneous Coronary Intervention: A Pilot Observational Study.
作者信息
Zaki Tarek, Labib Salwa, El-Abbady Maged, El-Kilany Wael, Mortada Ayman, Rashid Tarek, Ragy Hany, El-Itreby Adel, Nammas Wail
机构信息
Department of Cardiology, Faculty of Medicine, Ain Shams University.
National Heart Institute, Cairo, Egypt.
出版信息
Acta Cardiol Sin. 2017 May;33(3):258-265. doi: 10.6515/acs20161103a.
BACKGROUND
Glycoprotein IIb IIIa inhibitors improved short- and long-term outcome when added to primary percutaneous coronary intervention (PPCI) in patients with ST-segment-elevation myocardial infarction (STEMI). We hypothesized that intracoronary eptifibatide infusion via a perfusion catheter improves angiographic and clinical outcome of patients with STEMI undergoing PPCI, versus conventional intracoronary bolus injection.
METHODS
Prospectively, we enrolled 80 patients with acute STEMI and thrombolysis in myocardial infarction (TIMI) thrombus grade ≥ 2. Patients were assigned to receive eptifibatide (180 μg) either via a dedicated coronary perfusion catheter (ClearWay) during PPCI (group I), or guiding catheter (group II). Assessment of TIMI thrombus grade, TIMI flow grade, and TIMI myocardial perfusion (TMP) grade was performed both at baseline and post- procedurally. The primary 'angiographic' endpoint was final TMP grade 0/1. The primary 'clinical' endpoint was a composite of cardiac death, non-fatal re-infarction, target vessel revascularization, and recurrent ischemia at 30-day follow-up.
RESULTS
Mean age was 52.3 ± 8.9 years (17.5% females). Clearance of visible thrombus (TIMI thrombus grade 0) at final angiogram was more frequent in group I. Additionally, both final TIMI flow grade 3 and final TMP grade 3 occurred more frequently in group I. The primary angiographic endpoint was more frequent in group II versus group I (17.5% versus 0%, respectively, p = 0.001). The primary clinical endpoint was more frequent in group II (20% versus 0%, respectively, p = 0.003).
CONCLUSIONS
In patients with STEMI, intracoronary eptifibatide infusion via a perfusion catheter during PPCI improved immediate angiographic outcome, and reduced clinical events at 30-day follow-up, versus bolus injection via the guiding catheter.
背景
在接受直接经皮冠状动脉介入治疗（PPCI）的ST段抬高型心肌梗死（STEMI）患者中，糖蛋白IIb/IIIa抑制剂在加入治疗后可改善短期和长期预后。我们假设，与传统冠状动脉内推注相比，通过灌注导管冠状动脉内输注依替巴肽可改善接受PPCI的STEMI患者的血管造影和临床预后。
方法
前瞻性地，我们纳入了80例急性STEMI且心肌梗死溶栓（TIMI）血栓分级≥2级的患者。患者被分配接受依替巴肽（180μg），要么在PPCI期间通过专用冠状动脉灌注导管（ClearWay）给药（I组），要么通过引导导管给药（II组）。在基线和术后均对TIMI血栓分级、TIMI血流分级和TIMI心肌灌注（TMP）分级进行评估。主要“血管造影”终点是最终TMP分级为0/1。主要“临床”终点是30天随访时心脏死亡、非致命性再梗死、靶血管血运重建和复发性缺血的复合终点。
结果
平均年龄为52.3±8.9岁（女性占17.5%）。I组在最终血管造影时可见血栓清除（TIMI血栓分级为0）更为常见。此外，I组最终TIMI血流分级为3级和最终TMP分级为3级的情况也更频繁。主要血管造影终点在II组比I组更常见（分别为17.5%和0%，p = 0.001）。主要临床终点在II组更常见（分别为20%和0%，p = 0.003）。
结论
在STEMI患者中，与通过引导导管推注相比，在PPCI期间通过灌注导管冠状动脉内输注依替巴肽可改善即时血管造影预后，并减少30天随访时的临床事件。
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