Kararsız anjina pektoris ve non-st eleve miyokard ınfarktüsünde tirofiban tedavisinin st segment rezolusyonu üzerine etkisi

Abstract

Akut koroner sendromlu hastaların büyük kısmını kapsayan kararsız anjina pektoris ve non-ST miyokard infarktüsü (MI) hastalarında konvansiyonel tedaviye eklenen küçük moleküllü bir GP IIb-IIIa reseptör inhibitörü olan tirofibanın. ST rezolüsyonu ile ilişkisini değerlendirmek istedik. Çalışma süresince toplam 57 hasta konvansiyonel ve konvansiyonel tedaviye ek olarak tirofiban grubuna ayrıldı. Tirofiban grubuna 31, konvansiyonel gruba ise 26 hasta alındı. Tirfiban grubunun yaş ortalaması 59.7742, konvansiyonel grubun yaş ortalaması 59.1154 olarak bulundu Yaş aralığı ise 36-80 yıl idi. Çalışmaya alınan tüm hastalarda troponin T pozitif ve bazal EKG de ST depresyonu vardı. Hastalar ortalama bir hafta kadar hospitalize edildiler. Her iki hasta grubu yaş, cinsiyet ve diğer KVS risk faktörleri açısından birbirine benzer bulundu. Bazale kıyasla 4. ve 24. saat EKG'lerinde anlamlı ST resolüsyonu bulunmazken 72. saat EKG'sinde ST rezolüsyonunun anlamlılık düzeyine ulaştığı gözlendi (p=0.045)

ST segment resolution in ST elevated myocardial infarction has independent predictive value for congestive heart failure and death at 30 days. ST segment depression in unstable angina pectoris (UAP) and non-ST elevated myocardial infarction (NSTEMI) predicts high risk of MI and death and may discriminate patients likely to have greater benefit from aggressive antithrombotic and interventional therapy. This study assessed the effect of tirofiban added to conventional treatment on ST segment resolution in NSTEMI patients. Sixty-four patients were randomized to one of the two groups: 32 patients received conventional treatment while tirofiban was added in the second group of 32 patients. In the first group, 6 patients refused to participate further after giving initial informed consent while 1 patient in the tirofiban group dropped out. We had 26 patients (mean age, 59 years) in the conventional treatment group and 31 patients (mean age, 59 years) received also tirofiban. Tirofiban was administered by intravenous infusion over a 72 hour period. More than 50% regression of depression was considered to be ST segment resolution. The characteristics of the two groups were comparable (Table I). The ST segment resolution evolution did not differ at the 4th and 24th hours between the two groups. Significant differences occurred in the 72nd hour ECG (Table III). ST resolution was present in 67.9% of the tirofiban patients and in 32.1% of the conventional treatment group (P < 0.05). Tirofiban treatment was not associated with an increase in major bleeding even though there was a trend toward an increase in minor bleeding cases and did not influence the occurrence of refractory angina pectoris.