Wang Haixia, Feng Meiqin
Department Pharmacy, the Second Clinical Hospital of Shanxi Medical University, Taiyuan, Shanxi.
AstraZeneca (Wuxi) trading co. LTD, Wuxi, Jiangsu, China.
Medicine (Baltimore). 2020 Jun 5;99(23):e20402. doi: 10.1097/MD.0000000000020402.
Tirofiban is widely used in patients with acute ST elevation myocardial infarction (STEMI) underwent percutaneous coronary intervention (PCI). This drug can efficiently improve myocardial perfusion and cardiac function, but its dose still remains controversial. We here investigated the effects of different dose of tirofiban on myocardial reperfusion and heart function in patients with STEMI. A total of 312 STEMI patients who underwent PCI in our hospital from March 2017 to March 2018 were enrolled and randomly divided into control group (75 cases, 0 μg/kg), low-dose group (79 cases, 5 μg/kg), medium-dose group (81 cases, 10 μg/kg) and high-dose group (77 cases, 20 μg/kg). The infarction-targeted artery flow grade evaluated by thrombolysis in myocardial infarction (TIMI), corrected TIMI frame count (CTFC) and sum-ST-segment resolution were recorded. At Day 7 and Day 30 after PCI, the left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter, left ventricular end systolic diameter, major adverse cardiovascular events and the hemorrhage and thrombocytopenia were also evaluated. After PCI, the rate of TIMI grade 3, CTFC and incidence of sum-ST-segment resolution > 50% of high-dose group were significantly higher than those of control group, low-dose group and medium-dose group (P < .05), and the CTFC of medium -dose group were significantly higher than that of control group, low-dose group (P < .05). Moreover, the LVEF, left ventricular end diastolic diameter and left ventricular end systolic diameter of high-dose group were significantly improved than those of other groups, and the LVEF of medium-dose group was significantly superior to that of low-dose group (P < .05). However, the incidence of major adverse cardiac events in high-dose group was significantly decreased, while the hemorrhage and incidence of thrombocytopenia of high-dose group were significantly higher than those of other 3 groups (P < .05). The tirofiban can effectively alleviate the myocardial ischemia-reperfusion injury and promote the recovery of cardiac function in STEMI patients underwent PCI. Although the high-dose can enhance the clinical effects, it also increased the hemorrhagic risk. Therefore, the rational dosage application of tirofiban become much indispensable in view of patient's conditions and hemorrhagic risk, and a medium dose of 10 μg/kg may be appropriate for patients without high hemorrhagic risk.
替罗非班广泛应用于接受经皮冠状动脉介入治疗（PCI）的急性ST段抬高型心肌梗死（STEMI）患者。这种药物能有效改善心肌灌注和心脏功能，但其剂量仍存在争议。我们在此研究了不同剂量替罗非班对STEMI患者心肌再灌注和心脏功能的影响。选取2017年3月至2018年3月在我院接受PCI的312例STEMI患者，随机分为对照组（75例，0μg/kg）、低剂量组（79例，5μg/kg）、中剂量组（81例，10μg/kg）和高剂量组（77例，20μg/kg）。记录采用心肌梗死溶栓治疗（TIMI）评估的梗死相关动脉血流分级、校正TIMI帧数（CTFC）和ST段总和回落情况。在PCI术后第7天和第30天，还评估左心室射血分数（LVEF）、左心室舒张末期内径、左心室收缩末期内径、主要不良心血管事件以及出血和血小板减少情况。PCI术后，高剂量组的TIMI 3级血流率、CTFC以及ST段总和回落>50%的发生率均显著高于对照组、低剂量组和中剂量组（P<0.05），中剂量组的CTFC显著高于对照组和低剂量组（P<0.05）。此外，高剂量组的LVEF、左心室舒张末期内径和左心室收缩末期内径较其他组有显著改善，中剂量组的LVEF显著优于低剂量组（P<0.05）。然而，高剂量组主要不良心脏事件的发生率显著降低，而高剂量组的出血和血小板减少发生率显著高于其他3组（P<0.05）。替罗非班能有效减轻接受PCI的STEMI患者的心肌缺血再灌注损伤，促进心脏功能恢复。虽然高剂量可增强临床疗效，但也增加了出血风险。因此，鉴于患者情况和出血风险，合理应用替罗非班剂量非常必要，对于无高出血风险的患者，10μg/kg的中剂量可能较为合适。
