关键词: 心肌梗死, 血管成形术, 气囊, 冠状动脉, 依替巴肽, 替罗非班, 疗效比较研究

Abstract: Background　Continuous intravenous infusion of small molecule platelet glycoprotein （GP） Ⅱb/Ⅲa receptor antagonist （GPI） can improve the prognosis of patients with acute ST-segment elevation myocardial infarction （STEMI） who had undergone primary percutaneous coronary intervention （PCI）.However,this treatment method can increase bleeding events.Therefore,the safety of the intracoronary eptifibatide only strategy and the intracoronary tirofiban only strategy are worth exploring.Objective　To compare the safety of intracoronary eptifibatide only strategy or intracoronary tirofiban only strategy during primary PCI of acute STEMI patients.Methods　A total of 135 cases of acute STEMI patients admitted into Dalian Municipal Center Hospital from March 2014 to September 2015 and in line with the inclusion standards retrospectively，which were divided into eptifibatide group （n=62） and tirofiban group （n=73） according to the intracoronary eptifibatide or tirofiban during primary PCI.The baseline characteristics of patients in the two groups were collected,including age,gender,body mass index,smoking,diabetes,hypertension,premature family history of coronary artery disease,Killip Ⅱ class and above,postoperative drug（β receptor blocker and ACE inhibitor） application,anterior wall myocardial infarction,infarct-related artery （left anterior descending,left circumflex artery,right coronary artery）,baseline thrombolysis in myocardial infarction （TIMI） flow grade of 0 or 1,the time from onset to balloon dilatation and thrombus aspiration.The TIMI flow grade,corrected TIMI frame count（cTFG）,ST-segment resolution,left ventricular ejection fraction （LVEF）,left ventricular end diastolic diameter （LVEDD）,ventricular wall motion abnormalities,the incidence of bleeding events and thrombocytopenia in hospital,as well as the incidence of major adverse cardiac events （including all-cause death,stent thrombosis,emergency coronary revascularization,myocardial infarction） on 30 days after PCI of patients were compared between the two groups after completion of primary PCI.Results　The difference between the two groups in age,gender,body mass index,smoking,diabetes positive rate,hypertension positive rate,positive rate of premature family history of coronary artery disease,incurrence of Killip Ⅱ class and above,postoperative drug application （β receptor blocker and ACE inhibitor）,anterior wall myocardial infarction,infarct related artery,baseline TIMI flow grade of 0 or 1,time from onset to balloon dilatation and thrombus aspiration were not statistically significant （P>0.05）.The difference between the two groups in TIMI flow grade,cTFG,ST-segment resolution,LVEF,LVEDD and ventricular wall motion abnormalities of patients after completion of primary PCI were not statistically significant （P>0.05）.The incidence of thrombocytopenia in tirofiban group was higher than eptifibatide group（P<0.05）.The difference between the two groups of incidence of bleeding events in hospital and major adverse cardiac events on 30 days after PCI were not statistically significant （P>0.05）.Conclusion　The intracoronary eptifibatide only strategy and the intracoronary tirofiban only strategy have satisfactory curative effect during primary PCI of acute STEMI patients，however，the intracoronary eptifibatide only strategy seems to be safer.

Key words: Myocardial infarction, Angioplasty,balloon,coronary, Eptifibatide, Tirofiban, Comparative effectiveness research