Velibey Yalcin, Guvenc Tolga Sinan, Demir Koray, Oz Ahmet, Akdeniz Evliya, Guvenc Rengin Cetin, Guzelburc Ozge, Yildiz Ufuk, Safak Aylin, Kalenderoglu Koray, Tekkesin Ahmet Ilker
1 Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey.
2 Department of Cardiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
Angiology. 2019 May;70(5):431-439. doi: 10.1177/0003319718808911. Epub 2018 Oct 28.
We retrospectively analyzed short- and long-term outcomes of patients who received bailout tirofiban during primary percutaneous intervention (pPCI). A total of 2681patients who underwent pPCI between 2009 and 2014 were analyzed; 1331 (49.6%) out of 2681 patients received bailout tirofiban. Using propensity score matching, 2100 patients (1050 patient received bail-out tirofiban) with similar preprocedural characteristics were identified. Patients who received bailout tirofiban had a significantly higher incidence of acute stent thrombosis, myocardial infarction, and major cardiac or cerebrovascular events during the in-hospital period. There were numerically fewer deaths in the bailout tirofiban group in the unmatched cohort (1.7% vs 2.5%, P = .118). In the matched cohort, in-hospital mortality was significantly lower (1.1% vs 2.4%, P = .03), and survival at 12 and 60 months were higher (96.9% vs 95.2%, P = .056 for 12 months and 95.1% vs 92.0%, P = .01 for 60 months) in the bailout tirofiban group. After multivariate adjustment, bailout tirofiban was associated with a lower mortality at 12 months (odds ratio [OR]: 0.554, 95% confidence interval [CI], 0.349-0.880, P = .012) and 60 months (OR: 0.595, 95% CI, 0.413-0.859, P = .006). In conclusion, bailout tirofiban strategy during pPCI is associated with a lower short- and long-term mortality, although in-hospital complications were more frequent.
我们回顾性分析了在直接经皮冠状动脉介入治疗(pPCI)期间接受补救性替罗非班治疗的患者的短期和长期预后。对2009年至2014年间接受pPCI的2681例患者进行了分析;2681例患者中有1331例(49.6%)接受了补救性替罗非班治疗。采用倾向评分匹配法,确定了2100例(1050例接受补救性替罗非班治疗)术前特征相似的患者。接受补救性替罗非班治疗的患者在住院期间发生急性支架血栓形成、心肌梗死以及重大心脏或脑血管事件的发生率显著更高。在未匹配队列中,补救性替罗非班组的死亡人数在数值上较少(1.7%对2.5%,P = 0.118)。在匹配队列中,补救性替罗非班组的住院死亡率显著更低(1.1%对2.4%,P = 0.03),且在12个月和60个月时的生存率更高(12个月时为96.9%对95.2%,P = 0.056;60个月时为95.1%对92.0%,P = 0.01)。经过多变量调整后,补救性替罗非班与12个月时较低的死亡率相关(比值比[OR]:0.554,95%置信区间[CI],0.349 - 0.880,P = 0.012)以及60个月时较低的死亡率相关(OR:0.595,95% CI,0.413 - 0.859,P = 0.006)。总之,pPCI期间的补救性替罗非班策略与较低的短期和长期死亡率相关,尽管住院期间并发症更常见。