半剂量替罗非班辅助经皮冠状动脉介入术治疗老年急性ST段抬高心肌梗死患者的临床研究

Clinical research on effect of half dose tirofiban assisted PCI on myocardial perfusion and safety in elderly patients with acute STEMI

摘要:

目的 探讨半剂量替罗非班辅助急诊经皮冠状动脉介入术（PCI）对老年急性ST段抬高心肌梗死（STEMI）患者的影响。方法 选取2020年5月—2021年5月在沧州市中心医院行急诊PCI治疗的STEMI老年患者98例，随机分为两组，每组49例。其中，A组给予标准剂量替罗非班治疗，B组给予半剂量替罗非班治疗。观察两组TIMI血流分级及校正的TIMI计帧数（CTFC）、左室射血分数（LVEF）、左室收缩末期内径（LVESD）、左室舒张末期内径（LVEDD）、心肌肌钙蛋白（cTnⅠ）、N端前脑钠肽（NT-proBNP）、肌酸激酶同工酶（CK-MB）水平，记录两组治疗期间主要心血管不良事件（MACE）及出血并发症的情况。结果 两组术后TIMI血流分级、CTFC、LVEF、LVESD、LVEDD比较，差异无统计学意义（P >0.05）；两组术后LVEF高于术前，LVEDD及LVESD小于术前（P <0.05）；B组术后血清cTnⅠ、CK-MB及NT-proBNP水平比A组低（P <0.05）；B组MACE总发生率（2.04%）与A组（8.16%）比较，差异无统计学意义（P >0.05）；B组出血总发生率（2.04%）低于A组（16.33%）（P <0.05）。结论 半剂量替罗非班辅助PCI治疗老年急性STEMI患者的临床疗效较好，可有效改善患者心肌灌注水平、降低心肌损伤、降低出血并发症，且不增加MACE发生率，安全性较高。

Abstract:

Objective To evaluate the effect of half dose tirofiban assisted percutaneous coronary intervention (PCI) on myocardial perfusion and safety in elderly patients with ST segment elevation myocardial infarction (STEMI).Methods This study was a randomized-controlled trial, and 98 elderly patients who underwent emergency PCI in STEMI in Cangzhou Central Hospital from May 2020 to May 2021 were randomly divided into two groups. 49 cases in group A were treated with standard dose tirofiban and half dose tirofiban in group B. The levels of myocardial perfusion TIMI grade and TIMI count frame, cardiac function index [ left ventricular ejection fraction (LVEF), LV end systolic internal diameter (LVESD), LV terminal diastolic internal diameter (LVEDD) ], serum myocardial injury markers [myocardial troponin (cTnI), N terminal forebrain sodium peptide (NT-proBNP), creatine kinase isoenzyme (CK-MB)], and the occurrence of cardiovascular adverse events (MACE), and bleeding complications were recorded in both groups.Results There was no significant difference in TIMI grade, cTFC, and cardiac function between the two groups (P > 0.05); LVEF increased, and LVEDD and LVESD decreased in the two groups after treatment compared with before treatment (P < 0.05); LVEF after treatment was higher than that before treatment, LVEDd and LVESD were lower than those before treatment (P < 0.05); The levels of serum CTN Ⅰ, CK-MB, and NT proBNP in group B were lower than those in group A (P < 0. 05); The total incidence of mace in group B (2.04%) was not significantly different from that in group A (8.16%) (P > 0.05); The total incidence of bleeding in group B (2.04%) was lower than that in group A (16.33%) (P < 0.05).Conclusion Half dose tirofiban assisted PCI is effective in the treatment of senile acute STEMI. It can effectively improve the level of myocardial perfusion, reduce the incidence of bleeding complications, and does not increase the incidence of mace.