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补救性替罗非班对接受直接经皮冠状动脉介入治疗的ST段抬高型心肌梗死患者院内结局及长期死亡率的影响

Effects of Bailout Tirofiban on In-Hospital Outcomes and Long-Term Mortality in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Intervention.

作者信息

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

机构信息

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.

出版信息

Angiology. 2019 May;70(5):431-439. doi: 10.1177/0003319718808911. Epub 2018 Oct 28.

Abstract

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.

摘要

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。

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