Zhang Z, Li W, Wu W, Xie Q, Li J, Zhang W, Zhang Y
Department of Cardiology, Panyu Central Hospital (Cardiovascular Institute of Panyu District), 511400, Guangzhou, China.
Department of Cardiology, Ganzhou City People's Hospital, 341000, Ganzhou, China.
Herz. 2020 May;45(3):280-287. doi: 10.1007/s00059-018-4716-0. Epub 2018 Jun 12.
There is no consensus on the use of thrombus aspiration (TA) in primary percutaneous coronary intervention (PPCI), and few studies have focused on the performance of tirofiban via TA catheter after PPCI. Our study investigated the clinical outcome of tirofiban injection through TA in acute ST-segment elevation myocardial infarction (STEMI) patients with large thrombus burden undergoing PPCI treatment.
The study comprised 122 STEMI patients who underwent TA during PPCI. Participants were randomly divided into two groups. Group A received intravenous tirofiban injection and tirofiban injection via a TA catheter to the infarcted coronary artery after aspiration (n = 61). Group B received intravenous tirofiban injection only (n = 61). Baseline clinical information and follow-up data were collected for both groups. Coronary angiography, electrocardiography, and echocardiography findings as well as major adverse cardiovascular events (MACE) were recorded.
There were significant differences in postprocedural Thrombolysis in Myocardial Infarction (TIMI) grade 2 and 3 flow between the two groups (p = 0.021, p = 0.006, respectively). The incidence of slow-flow in group A was significantly lower than that of group B (p = 0.011). An increased incidence of no ST-segment resolution was observed in group B (p = 0.011). There were fewer major adverse cardiovascular events in group A than in group B, but the difference was not statistically significant.
Selective tirofiban injection via TA catheter during PPCI may improve myocardial reperfusion in STEMI patients with large thrombus burden.
在直接经皮冠状动脉介入治疗（PPCI）中，对于血栓抽吸（TA）的应用尚无共识，并且很少有研究关注PPCI后通过TA导管给予替罗非班的效果。我们的研究调查了在接受PPCI治疗、血栓负荷较大的急性ST段抬高型心肌梗死（STEMI）患者中，通过TA注入替罗非班的临床结局。
本研究纳入了122例在PPCI期间接受TA的STEMI患者。参与者被随机分为两组。A组在血栓抽吸后经静脉注射替罗非班，并通过TA导管向梗死相关冠状动脉注射替罗非班（n = 61）。B组仅接受静脉注射替罗非班（n = 61）。收集两组的基线临床信息和随访数据。记录冠状动脉造影、心电图、超声心动图检查结果以及主要不良心血管事件（MACE）。
两组术后心肌梗死溶栓（TIMI）2级和3级血流存在显著差异（分别为p = 0.021，p = 0.006）。A组慢血流发生率显著低于B组（p = 0.011）。观察到B组ST段未回落发生率增加（p = 0.011）。A组主要不良心血管事件少于B组，但差异无统计学意义。
在PPCI期间通过TA导管选择性注射替罗非班可能改善血栓负荷较大的STEMI患者的心肌再灌注。
