Department of Cardiology, The First Hospital of QinHuangDao, QinHuangDao, 066000 HeBei, China.
Department of Critical Care Medicine, People's Hospital of Yangjiang, Yangjiang, 529500, Guangdong, China.
Curr Vasc Pharmacol. 2024;22(1):41-49. doi: 10.2174/0115701611251882231012080210.
This study evaluated the efficacy and safety of early vs. late tirofiban administration in the treatment of patients with acute ST-elevation myocardial infarction (STEMI) and diabetes mellitus (DM) undergoing primary percutaneous coronary intervention (pPCI).
120 patients with STEMI and DM treated with pPCI were randomly divided into an observation group (n=60) and a control group (n=60). The observation group and the control group were intravenously injected with a bolus of tirofiban preoperatively or intraoperatively, respectively; both groups were then given an intravenous infusion over 24 h at 0.15 μg/kg/min. Thrombolysis in myocardial infarction (TIMI) grade flow, myocardial perfusion index, and functional heart parameters, as well as major adverse cardiovascular events and bleeding, were compared between the two groups.
Functional heart parameters, including left ventricular ejection fraction and cardiac output, were significantly improved in the observation group 6 months after discharge. Thrombus aspiration, inflammatory factors, and cardiac troponin I (cTNI) were more significantly decreased in the observation group than in the control group. The sum-ST-segment elevation at 2 h after pPCI treatment in the observation group was better than that in the control group. There was no significant difference in the incidence of adverse reactions and bleeding between the two groups.
The administration of tirofiban before reperfusion therapy compared with after reperfusion therapy is more effective in reducing the hyperthrombotic load, thrombus aspiration, inflammatory factors, and cTNI and can effectively improve myocardial perfusion and heart function.
本研究评估了早期与晚期替罗非班给药在伴糖尿病的急性 ST 段抬高型心肌梗死（STEMI）患者行直接经皮冠状动脉介入治疗（pPCI）中的疗效和安全性。
120 例行 pPCI 的 STEMI 合并糖尿病患者随机分为观察组（n=60）和对照组（n=60）。观察组和对照组患者分别于术前和术中静脉推注替罗非班负荷量，随后以 0.15 μg/kg/min 的速率静脉输注 24 h。比较两组患者的心肌梗死溶栓治疗（TIMI）血流分级、心肌灌注指数以及心功能参数，同时比较两组主要不良心血管事件（MACE）和出血情况。
观察组出院后 6 个月心功能参数，包括左心室射血分数和心输出量，均显著改善。观察组血栓抽吸、炎症因子和心肌肌钙蛋白 I（cTNI）较对照组显著降低。观察组 pPCI 治疗后 2 h 的总和 ST 段抬高幅度优于对照组。两组不良反应和出血发生率无显著差异。
与再灌注治疗后给药相比，替罗非班在再灌注治疗前给药可更有效地降低高血栓负荷、血栓抽吸、炎症因子和 cTNI，有效改善心肌灌注和心功能。
