Zhang Jing, Ding Guomin
Department of Cardiology, People's Hospital of Anji, Huzhou, China.
Evid Based Complement Alternat Med. 2021 Jun 16;2021:8371996. doi: 10.1155/2021/8371996. eCollection 2021.
ST-segment elevation myocardial infarction (STEMI) is one of the acute coronary syndromes, and it is the main cause of cardiac death worldwide. The purpose of this study was to investigate whether tirofiban improves cardiac function and attenuates inflammatory response in STEMI patients undergoing percutaneous coronary intervention (PCI). From May 2016 to May 2019, a total of 124 patients who admitted into our hospital due to STEMI fulfilled inclusion and exclusion criteria and were randomly assigned to PCI + tirofiban and PCI groups, 62 cases per groups. Intravenous administration of 10 g kg min tirofiban was performed 30 min prior to PCI. During PCI, tirofiban infusion through a micropump with 0.15 g kg min lasted for 48 h. It was found that the PCI + tirofiban group was significantly different from the PCI group in total corrected TIMI frame count (CTFC) after PCI (15.88 ± 5.11 vs. 22.47 ± 6.26, < 0.001). At day 7 and day 30 post-PCI, a significant time-dependent decrease in the levels of brain natriuretic peptide (BNP), cardiac troponin I (cTnI), and creatine kinase isoenzyme (CK-MB) in both groups was observed after PCI ( < 0.001). More importantly, the patients in the PCI + tirofiban group had much lower levels of BNP, cTnI, and CK-MB compared with those in the PCI group at days 7 and 30 post-PCI ( < 0.001). At day 7 following PCI, the left ventricular ejection fraction (LVEF) was statistically higher in the PCI + tirofiban group than in the PCI group ( < 0.05). At day 30 post-PCI, increased LVEF concomitant with reduced left ventricular end diastolic diameter (LVEDD) and left ventricular end systolic diameter (LVESD) was observed in the PCI + tirofiban group compared with the PCI group. At day 7 and day 30 post-PCI, both groups displayed a time-dependent decline in the levels of C reactive protein (CRP), tumor necrosis factor- (TNF-), interleukin-6 (IL-6), and procalcitonin (PCT) after PCI ( < 0.05). Additionally, the patients in the PCI + tirofiban group had lower levels of CRP, TNF-, IL-6, and PCT compared with those in the PCI group at days 7 and 30 post-PCI ( < 0.05). All patients in the PCI + tirofiban and PCI groups were followed up for 12 months by outpatient or telephone after discharge. There were fewer patients with LVEF < 50% in the PCI + tirofiban group than the PCI group (=0.044). Furthermore, it was found that the incidence rate of major adverse cardiovascular events (MACEs) in the PCI + tirofiban group was evidently lower than that in the PCI group (12.90% vs. 29.03%, =0.028). Taken together, our data suggest that additional administration of tirofiban could improve cardiac function and attenuate inflammatory response in STEMI patients undergoing PCI, which is worthy of promotion in clinic.
ST段抬高型心肌梗死（STEMI）是急性冠状动脉综合征之一，也是全球心脏性死亡的主要原因。本研究旨在探讨替罗非班是否能改善接受经皮冠状动脉介入治疗（PCI）的STEMI患者的心功能并减轻炎症反应。2016年5月至2019年5月，共有124例因STEMI入院的患者符合纳入和排除标准，并被随机分为PCI +替罗非班组和PCI组，每组62例。在PCI术前30分钟静脉注射10μg·kg⁻¹·min⁻¹替罗非班。在PCI过程中，通过微量泵以0.15μg·kg⁻¹·min⁻¹输注替罗非班持续48小时。结果发现，PCI +替罗非班组与PCI组术后的总校正TIMI帧数（CTFC）有显著差异（15.88±5.11对22.47±6.26，P<0.001）。在PCI术后第7天和第30天，两组患者术后脑钠肽（BNP）、心肌肌钙蛋白I（cTnI）和肌酸激酶同工酶（CK-MB）水平均出现显著的时间依赖性下降（P<0.001）。更重要的是，PCI +替罗非班组患者在PCI术后第7天和第30天的BNP、cTnI和CK-MB水平明显低于PCI组（P<0.001）。在PCI术后第7天，PCI +替罗非班组的左心室射血分数（LVEF）在统计学上高于PCI组（P<0.05）。在PCI术后第30天，与PCI组相比，PCI +替罗非班组观察到LVEF增加，同时左心室舒张末期内径（LVEDD）和左心室收缩末期内径（LVESD）减小。在PCI术后第7天和第30天，两组患者术后C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）和降钙素原（PCT）水平均出现时间依赖性下降（P<0.05）。此外，PCI +替罗非班组患者在PCI术后第7天和第30天的CRP、TNF-α、IL-6和PCT水平低于PCI组（P<0.05）。PCI +替罗非班组和PCI组的所有患者出院后均通过门诊或电话随访12个月。PCI +替罗非班组中LVEF<50%的患者少于PCI组（P = 0.044）。此外，发现PCI +替罗非班组的主要不良心血管事件（MACE）发生率明显低于PCI组（12.90%对29.03%，P = 0.028）。综上所述，我们的数据表明，额外给予替罗非班可改善接受PCI的STEMI患者的心功能并减轻炎症反应，值得在临床上推广。
