摘要
尽早、充分、持久开通梗死相关动脉(infarctionrelated artery,IRA),保护左室功能,减少心肌梗死面积,是降低ST段抬高心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者死亡率、改善临床预后的关键^([1])。溶栓和直接经皮冠状动脉介入治疗(primary percutaneous coronary in tervention,PCI)作为STEMI再灌注治疗的主要方法,具有备自的优势和不足^([2])。近期研究表明,对于首诊于无PCI条件医院的STEMI患者。
Consecutive STEMI patients undergoing early PCI within 24 h of thrombolysis and admitted from December 2010 to December 2011 were randomly assigned to 4 groups:primary PCI group(PCI group),anisodsamine infusion group(ANI group),tirofiban infusion group(TIR group) and PCI with both treatments group(ANI+TIR group).PCI was performed according to the result of CAG.After coronary angiography,but before the first balloon inflation,patients in the ANI group and TIR+ ANI group received intracoronary bolus injection of anisodamine,and the same vulome of 0.9%sodium chloride in the other two groups.Tirofiban was administered in TIR group and ANI+TIR group and the same vulome of 0.9%sodium chloride in the remaining patients.TIMI flow grade(TFG),corrected TIMI frame count(CTFC),TIMI myocardial perfusion grade(TMPG) and thrombosis score before and after PCI were recorded.Serum creatine kinase(CK),MB fraction(CK-MB),and standard 12-lead ECGs were recorded at admission.Echocardiographic examination was performed at discharge by a cardiologist blinded to the randomization results.The occurrence of MACE was compared among the groups.There was a trend of more patients achieving post-procedural TIMI 3 flow in the ANI + TIR group,compared to the primary PCI group(95.8%vs.75.0%,P = 0.084).The post-procedural CTFC in ANI+TIR group was less than the other three groups(P = 0.002),while the post-procedural CTFC in both ANI group and TIR group were improved.There was also a possible interaction regarding CTFC with the P = 0.765 of anisodamine + tirofiban.There was a trend of more complete STR in both ANI group and TIR group than that in primary PCI group,and a significant difference of more complete STR in ANI+TIR group was found than that in primary PCI group(91.7%vs.58.3%,P = 0.039).There was a trend of high level of peak CK-MB in primary PCI group(P = 0.245).No significant difference of bleeding complications was found among groups.There was a trend of higher LVEF at discharge in the TIR+ANI group,compared to the primary PCI group[(56.19%±4.05%) vs.(50.70%±7.35%),P = 0.005)].No significant difference of occurrence of MACE was found among groups(P = 0.686).
出处
《临床心血管病杂志》
CAS
CSCD
北大核心
2015年第12期1344-1349,共6页
Journal of Clinical Cardiology
基金
河北省2014年度医学科学研究重点课题计划(No:ZL20140074)