Аннотация
Цель: оценить эффективность и осложнения при использовании тирофибана у больных с острым коронарнымсиндромом (ОКС) с подъемом сегмента ST при спасательной коронарной ангиопластике после неудачноготромболизиса.Материалы и методы. В исследование было включено 112 пациентов, которые были рандомизированы на 2группы: в 1-й группе выполнялось спасательное чрескожное коронарное вмешательство (ЧКВ) со стентированием, во2-й группе пациентам назначался тирофибан и выполнялось спасательное ЧКВ.Результаты. Оценка ближайших результатов (0–30 дней) показала, что по частоте (1-й группе – 13,7%, 2-й груп-па – 19,2%) и выраженности кровотечений достоверных различий между группами не было (p>0,05). В группе ти-рофибана был отмечен достоверный прирост фракции выброса левого желудочка: 6±3% против 3±5% в 1-й груп-пе (p=0,005). Поздние события (31–180 дней) достоверно реже встречались во 2-й группе пациентов (5,8% против21,6% в 1-й группе, p<0,05). Мультивариантный анализ показал, что развитие кардиогенного шока (ОШ=6,8, 95%ДИ: 1,8–26, р=0,005) было независимым фактором риска выраженных сердечно-сосудистых осложнений и собы-тий в течение 6 мес после ЧКВ. При этом только применение тирофибана во время ЧКВ имело достоверный эффектуменьшения выраженных сердечно-сосудистых осложнений и событий в течение 6 мес после ЧКВ (ОШ=0,15, 95% ДИ0,04–0,53, р=0,003).Выводы. Проведение экстренного ЧКВ в комбинации с терапией ингибитором IIb/IIIa гликопротеиновыхрецепторов тромбоцитов (тирофибаном) позволяет эффективно и безопасно достичь оптимальных результатов леченияпациентов с ОКС с подъемом сегмента ST после неудачного тромболизиса. Отдаленный прогноз у больных послеспасательного ЧКВ улучшается, если во время вмешательства пациент получает ингибитор IIb/IIIa гликопротеиновыхрецепторов тромбоцитов, но в то же время значительно ухудшается в случае развития кардиогенного шока.Purpose: To evaluate the efficacy and complications of Tirofiban in patients with acute coronary syndrome and ST- segmentelevation in the rescue recutaneous coronary angioplasty after failed thrombolysis.Materials and мethods. The study included 112 patients who were randomly assigned to two groups: in Group I therescue PCI with stenting was performed, in Group II the rescue PCI was added with Tirofiban.Results. While analyzing immediate outcomes (0–30 days), it has been shown that there were no significant differencesbetween incidence and severity parameters in the two groups: incidence (Group I – 13.7%, Group II – 19.2%) andseverity of bleeding (p> 0.05). In Tirofiban group there was a significant increase of left ventricle ejection fraction: 6 ± 3%vs 3 ± 5% in Group I (p = 0.005). Late events (31–180 days) were significantly less frequent in Group II (5.8% vs 21.6% inGroup I, p <0.05). The multivariate analysis showed that cardiogenic shock (OR = 6.8, 95% CI: 1.8–26, p = 0.005) was anindependent risk factor of marked cardiovascular complications and events within 6 months after PCI. Only Tirofiban duringPCI significantly weakened pronounced cardiovascular complications and events within 6 months after PCI (OR = 0.15, 95%CI: 0.4-0.53, p = 0.003).Conclusions. Urgent PCI in combination with administration of IIb / IIIa inhibitor of platelet glycoprotein receptors(Tirofiban) can effectively and safely achieve optimal results in patients with acute coronary syndrome and ST-segment elevationafter failed thrombolysis. Long-term prognosis in patients after rescue PCI may be improved if during the procedurepatients receive IIb / IIIa inhibitors of platelet glycoprotein receptors, but at the same time this prognosis gets much worsein case of cardiogenic shock.
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