孙宇珺,周雯,丁嵩,杨帆,孔令璁,高灵辰,李臻,赵航,龚兴荣,葛恒,卜军,何奔

• 1:上海交通大学医学院附属仁济医院心内科

摘要(Abstract)：

目的比较经靶向灌注导管和经指引导管冠状动脉内给予血小板糖蛋白Ⅱb/Ⅲa抑制剂替罗非班,对急性冠状动脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)术后的影响。方法回顾性分析113例在PCI术后发生TIMI血流分级≤Ⅱ级并由术者决定补救性冠状动脉内注射替罗非班的ACS患者。其中经靶向灌注导管给药组55例,经指引导管给药组58例。比较两组患者给药后心外膜冠状动脉灌注及心肌组织灌注水平、术后院内主要不良心脑血管事件(MACCE)及出血事件发生率。结果两组患者一般临床资料差异无统计学意义(均P>0.05)。给药后,经靶向灌注导管给药组心肌灌注水平显著优于经指引导管给药组(P=0.0172);住院期间,两组患者院内MACCE和出血事件发生率相当(P=0.471、P=0.901)。结论与经指引导管冠状动脉内给予替罗非班相比,经靶向灌注导管在靶病变远段给药显著改善ACS患者心肌组织灌注水平,两者院内MACCE及出血事件发生率相当。

关键词(KeyWords)： 急性冠状动脉综合征;经皮冠状动脉介入治疗;血小板糖蛋白Ⅱb/Ⅲa抑制剂;心肌灌注

Abstract:

Keywords:

基金项目(Foundation): 上海市领军人才和上海市医学领军人才项目(LJ10007);; 上海申康新兴前沿技术项目(SHDC12013119);; 上海市曙光人才计划(12SG22)

作者(Author): 孙宇珺,周雯,丁嵩,杨帆,孔令璁,高灵辰,李臻,赵航,龚兴荣,葛恒,卜军,何奔

参考文献(References)：

• [1]Boden WE,Eagle K,Granger CB.Reperfusion strategies in acute ST-segment elevation myocardial infarction:a comprehensive review of contemporary management options.J Am Coll Cardiol,2007,50:917-29.
• [2]O'Gara PT,Kushner FG,Ascheim DD,et al.2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol,2013,61:e78-e140.
• [3]Pu J,Ding S,Shan P,et al.Comparison of epicardial and myocardial perfusions after primary coronary angioplasty for STelevation myocardial infarction in patients under and over 75 years of age.Aging Clin Exp Res,2010,22:295-302.
• [4]Roe MT,Ohman EM,Maas AC,et al.Shifting the open-artery hypothesis downstream:the quest for optimal reperfusion.J Am Coll Cardiol,2001,37:9-18.
• [5]Ding S,Pu J,Qiao ZQ,et al.TIMI myocardial perfusion frame count:a new method to assess myocardial perfusion and its predictive value for short-term prognosis.Catheter Cardiovasc Interv,2010,75:722-732.
• [6]Pu J,Ding S,He B.Rebuttal:TIMI myocardial perfusion frame count:an angiographic method to assess flow in the myocardium but not in the epicardial artery.Catheter Cardiovasc Interv,2010,76:1073-1075.
• [7]Pu J,Shan PR,Ding S,et al.Factors affecting thrombolysis in myocardial infarction myocardial perfusion frame count:insights of myocardial tissue-level reperfusion from a novel index for assessing myocardial perfusion.Chin Med J(Engl),2011,124:873-878.
• [8]Thiele H,Schindler K,Friedenberger J,et al.Intracoronary compared with intravenous bolus abciximab application in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention:the randomized Leipzig immediate percutaneous coronary intervention abciximab IV versus IC in ST-elevation myocardial infarction trial.Circulation,2008,118:49-57.
• [9]张奇,张瑞岩,胡健,等.急性ST段抬高心肌梗死患者急诊介入治疗单纯冠状动脉内注射替罗非班的疗效及安全性.中国介入心脏病学杂志,2014,22:483-487.
• [10]Yan HB,Li SY,Song L,et al.Thrombus aspiration plus intrainfarct-related artery administration of tirofiban improves myocardial perfusion during primary angioplasty for acute myocardial infarction.Chin Med J(Engl),2010,123:877-883.
• [11]Chesebro JH,Knatterud G,Roberts R,et al.Thrombolysis in Myocardial Infarction(TIMI)Trial,Phase I:A comparison between intravenous tissue plasminogen activator and intravenous streptokinase.Clinical findings through hospital discharge.Circulation,1987,76:142-154.
• [12]Cutlip DE,Windecker S,Mehran R,et al.Clinical end points in coronary stent trials:a case for standardized definitions.Circulation,2007,115:2344-2351.
• [13]Updated ESC Guidelines for managing patients with suspected non-ST-elevation acute coronary syndromes.Eur Heart J,2011,32:2909-2910.
• [14]Pu J,Mintz GS,Brilakis ES,et al.In vivo characterization of coronary plaques:novel findings from comparing greyscale and virtual histology intravascular ultrasound and near-infrared spectroscopy.Eur Heart J,2012,33:372-383.
• [15]Pu J,Mintz GS,Biro S,et al.Insights into echo-attenuated plaques,echolucent plaques,and plaques with spotty calcification:novel findings from comparisons among intravascular ultrasound,near-infrared spectroscopy,and pathological histology in 2,294 human coronary artery segments.J Am Coll Cardiol,2014,63:2220-2233.
• [16]De Luca G,Ucci G,Cassetti E,et al.Benefits from small molecule administration as compared with abciximab among patients with ST-segment elevation myocardial infarction treated with primary angioplasty:a meta-analysis.J Am Coll Cardiol,2009,53:1668-1673.
• [17]Kushner FG,Hand M,Smith SC,et al.2009 Focused Updates:ACC/AHA Guidelines for the Management of Patients With STElevation Myocardial Infarction(updating the 2004 Guideline and 2007 Focused Update)and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention(updating the 2005 Guideline and 2007 Focused Update):a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.Circulation,2009,120:2271-2306.
• [18]Shen J,Zhang Q,Zhang RY,et al.Clinical benefits of adjunctive tirofiban therapy in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.Coron Artery Dis,2008,19:271-277.
• [19]De Luca G,Verdoia M,Suryapranata H.Benefits from intracoronary as compared to intravenous abciximab administration for STEMI patients undergoing primary angioplasty:a metaanalysis of 8 randomized trials.Atherosclerosis,2012,222:426-433.
• [20]Okamura A,Ito H,Iwakura K,et al.Clinical implications of distal embolization during coronary interventional procedures in patients with acute myocardial infarction:quantitative study with Doppler guidewire.JACC Cardiovasc Interv,2008,1:268-276.
• [21]Romagnoli E,Burzotta F,Trani C,et al.Rationale for intracoronary administration of abciximab.J Thromb Thrombolysis,2007,23:57-63.