急性心肌梗塞經皮冠狀動脈介入性治療中使用靜脈內或冠狀動脈內推注Tirofiban的比較

Intravenous versus Intracoronary Administration of Tirofiban in Percutaneous Coronary Intervention for Acute Myocardial Infarction

實驗目的：本實驗的目的是要比較急性心肌梗塞經皮冠狀動脈介入性治療中使用冠狀動脈內和靜脈內推注Tirofiban的主要心臟不良事件暨治療後的併發症。實驗方法和結果：我們回顧2001年1月至2002年12月間發生急性心肌梗塞並接經皮冠狀動脈介入性治療的106位病人的病歷。在這些病人中，50位接受冠狀動脈內推注Tirofiban (10µg/kg),56位接受靜脈內推注Tirofiban (10µg/kg)。所有病人皆接受為期兩年每個月的追蹤。兩組病人中無發生主要心臟不良事件的比例分別為冠狀動脈內注射組0.72(95%CI=0.60,0.85)和靜脈注射組0.57(95%CI=0.43,0.71)，P值大於0.05。有高血壓，腎臟疾病，高白血球數量，較高的Killip等級和心率較快的病人發生主要心臟不良事件的風險明顯較高。結論：急性心肌梗塞并接受經皮冠狀動脈介入性治療的病人，接受冠狀動脈內推注Tirofiban的不良心臟事件發生率和靜脈內推注Tirofiban是相似的。

Purpose: The purpose of this study was to compare intracoronary and intravenous bo-lus administration of tirofiban during emergency percutaneous coronary intervention for acute myocardial infarction in terms of major adverse cardiac events and post-procedur-al complications. Methods and Results: The medical records of 106 patients with acute myocardial infarction who underwent percutaneous coronary interventions between January 2001 and December 2002 were retrospectively reviewed. Of these patients, 50 received an intracoronary bolus of tirofiban(10 µg/kg), and 56 received an intravenous bolus of tirofiban(10 µg/kg). All patients were followed up monthly for a period of 2 years. The proportions of patients who were free of major adverse cardiac events in the intracoronary and intrave-nous groups were 0.72 (95% CI = 0.60, 0.85) and 0.57 (95% CI = 0.43, 0.71), respectively (P > 0.05). Patients with hypertension, renal disease, high white blood cell count, high-er Killip status, and higher heart rate had a significantlyhigher risk of major adverse cardiac events. Conclusions: The patients with acute myocardial infarction who underwent emer-gency percutaneous coronary intervention and received an intracoronary bolus of tirofiba experienced similar rates of major adverse cardiac events compared to those treated with an intravenous bolus of tirofiban