摘要
目的：探讨替罗非班辅助急诊冠状动脉介入（PCI）治疗ST段抬高心肌梗死（STEMI）患者的安全性及近期预后。方法选择2008年12月至2012年6月行急诊PCI治疗的STEMI患者468例，根据是否使用替罗非班，分为替罗非班组（n=351）和对照组（n=117）。采用 Kaplan-Meier和Cox比例风险模型分析两组患者住院期间安全性指标（严重出血、轻微出血、血小板减少症）、术后30天和90天术后主要不良心血管事件（死亡、再梗死、靶血管血运重建）发生情况。结果替罗非班组住院期间安全性指标与对照组相比无统计学差异（P＞0.05）。替罗非班组30天（7.98%vs.16.24%, P=0.01）及90天（8.55%vs.19.66%，P=0.001）主要不良心血管事件（MACE）发生率均低于对照组。Kaplan-Meier生存分析显示，替罗非班组术后30天（Log Rank=7.977，P=0.005）及90天（Log Rank=12.371，P＜0.001）无MACE生存率显著高于对照组。Cox比例风险模型显示替罗非班使用可以减少术后30天（HR=0.443，95%CI：0.247～0793，P=0.006）MACE发生和90天（HR=0.391，95%CI：0.227～0.674，P=0.001）MACE发生的风险。结论替罗非班可改善经直接PCI治疗的STEMI患者短期临床预后，且安全性良好。
Objective To investigate the safety and short-term prognosis of PCI assisted with tirofiban in the patients with acute ST-segment elevation myocardial infarction （STEMI）. Methods The patients （n=468） with emergency PCI were chosen from Dec. 2008 to Jun. 2012, and divided into tirofiban group （n=351） and control group （n=117） according. The safety indexes （severe bleeding, mild bleeding and thrombocytopenia） were analyzed by using Kaplan-Meier and Cox proportional hazard models in the patients during hospitalization. The incidence of major adverse cardiovascular events （MACE, death, reinfarction and target vessel revascularization） was observed respectively 30 d and 90 d after the surgery. Results The safety indexes had no statistical difference between tirofiban group and control group （P〈0.05）. The incidence of MACE was lower in tirofiban group than that in control group after 30 d （7.98%vs. 16.24%, P=0.01） and 90 d （8.55%vs. 19.66%, P=0.001）. The survival analysis of Kaplan-Meier showed that survival rate without MACE was significantly higher in tirofiban group than that in control group after 30 d （Log Rank=7.977, P=0.005） and 90 d （Log Rank=12.371, P〈0.001）. Cox proportional hazard models showed that tirofiban reduced the incidence of MACE after 30 d （HR=0.443, 95%CI：0.247-0793, P=0.006） and 90 d （HR=0.391, 95%CI：0.227-0.674, P=0.001）. Conclusion Tirofiban can improve the short-term prognosis with higher safety in STEMI patients with direct PCI.
出处
《中国循证心血管医学杂志》
2014年第1期40-43,共4页
Chinese Journal of Evidence-Based Cardiovascular Medicine
基金
上海市宝山区科委课题(10-E-4)
关键词
替罗非班
急性心肌梗死
预后
经皮冠状动脉介入治疗
Tirofiban
Acute myocardial infarction
Prognosis
Percutaneous coronary intervention
作者简介
通讯作者：张俊峰，E—mail：jfzhang_dr@163．com
