| Background Acute myocardial infarction(AMI) is a common acute critical illness in the world, its main feature is the high morbidity and mortality. Etiology of AMI is due to a sharp decline or break in coronary blood flow, so that the corresponding severe myocardial ischemia and ultimately to persistent ischemic necrosis, AMI does serious harm to human life and health. With the development of economy and society, the process of human aging speeds up, cardiovascular events, especially congestive heart failure and malignant arrhythmia caused by myocardial infarction, is the main factor causing high morbidity and high mortality. China also has entered the stage of aging population, and therefore incidence of acute myocardial infarction is increasing year by year. The main emergency treatment principles of acute myocardial infarction is to take measures to restore myocardial blood perfusion as soon as possible, in order to save the dying myocardial and curb the scope of myocardial infarction and myocardial ischemia, ultimately protect and maintain normal physiological function of the heart and reduce the risk of complications.In addition, we should pay attention to long-term treatment with patients with acute myocardial infarction, for the prevention of re-infarction and sudden death. Meanwhile, in the course of treatment we should also prevent the development and progression of arterial atherosclerosis, or take appropriate measures to stabilize existing plaque regression. In recent years, as thrombolysis, percutaneous coronary intervention(PCI) and coronary artery bypass grafting is widely used in clinical practice, as well as new and effective drug is found, the treatment of acute myocardial infarction has made a breakthrough progress, effectively reduce the rate of myocardial infarction, and ultimately also effective improve the prognosis of patients with myocardial infarction.Percutaneous coronary intervention(PCI) is the most effective treatment in opening the stenosis or occluded coronary artery, especially in the treatment of patients who suffered from acute myocardial infarction. PCI is the least traumatic of many myocardial revascularization procedures used in clinical practice. It has a significant advantage on timely opening of occluded vessels, especially in the treatment of STEMI(ST-elevation elevation myocardial infarction).However, a large number of clinical studies both at home and abroad have shown that, despite PCI has a definite effect on the treatment of AMI, but during the PCI process damage to the vascular intima is unavoidable, activated platelet will increase the risk of thrombosis. So, anti-thrombosis treatment is particularly important during PCI procedure. Tirofiban is a platelet membrane glycoprotein IIb / IIIa receptor antagonist, a kind of anti-platelet drugs which can effectively inhibit thrombosis, so it is widely used in the treatment of AMI. Conventional routes of tirofiban administration are currently intravenous injection, but intracoronary injection can make drugs gether in the coronary artery lesions no experiencing the systemic circulation and liver metabolism, increase the effective drug concentration several hundred times within coronary microcirculation, and inhibit the function of platelet aggregation largely. In addition, intracoronary administration tirofiban also reduces the risk of distal microthrombotic embolization during PCI, so intracoronary administration tirofiban lead to an improvement in the circulation of the myocardium, and the improvement of reperfusion of infarct-related blood vessels. There are obvious advantages in improving the success rate of PCI treatment.Objective To observe the effects of different administration routes of tirofiban on left ventricular function and prognosis in ST-segment elevation acute myocardial infarction(AMI) and explore the mechanism, 95 patients with ST-segment elevation acute myocardial infarction undergoing PCI were selected, The two administration routes of tirofiban via intracoronary and intravenous administration was uesd, and the efficacy and utility of the two routes of administration were compared and the clinical characteristics of the two treatments were analyzed.In addition, the effects of different administration methods of tirofiban on platelet function and its mechanism were analyzed. The aim of this study is to provide the basis for the safety and efficacy of different routes of administration of tirofiban. It will provide a theoretical reference for the clinical application of tirofiban.Methods(1) 95 cases of ST-segment elevation acute myocardial infarction were selected at our hospital, Department of Cardiology in September 2014-June 2015. All patients were randomly divided into two groups according to random number table, named intravenous administration group and intracoronary administration group, intravenous administration group included 32 male cases, 14 female cases, age ranged from 54 to 81 years. And the average age was 64.34 ± 4.21 years; intracoronary administration group included 33 male cases, 16 female cases, age ranged from 53 to 78 years, the average age was 63.27 ± 5.07 years. Patients in the intravenous group received intravenous infusion of 10 μg / kg of tirofiban during PCI and intracoronary received infusion of 10 μg / kg of tirofiban in the intracoronary group. Baseline data were compared between the two groups. Platelet count(PLT) and platelet aggregation rate(PAR) were measured in the peripheral blood samples of the two groups. TIMI flow grade, left ventricular function, and adverse cardiovascular events were measured in both groups.(2) 95 patients with ST-segment elevation acute myocardial infarction were selected from September, 2014 to June, 2015 in our hospital. All patients were randomized into two groups, intravenous and intracoronary. Blood samples were collected from peripheral blood of the patients in the two groups. The baseline levels of platelet reactivity, residual platelet reactivity and platelet aggregation were measured before and after administration.(3) 95 patients with ST-segment elevation acute myocardial infarction were selected from September, 2014 to June, 2015 in our hospital. All patients were randomized into two groups, intravenous and intracoronary. platelet CD40 L expression was detected by flow cytometry. Serum levels of s CD40 L were detected by enzyme-linked immunosorbent assay(ELISA). Western blotting was used to detect the expression of serum MMP-2.Results(1) There was no significant difference between intravenous administration group and intracoronary administration group in gender, age, comorbidities(hypertension, diabetes, high cholesterol), infarct-related artery, symptoms- stent time and the quantity of the stent(P> 0.05).After stent implantation,the rate of TIMI 0 grade and 1 grade had no significant difference between the two groups(P> 0.05),the rate of TIMI 2 grade was significantly more in intravenous administration group than intracoronary administration group(36.96% vs 24.49%)(P< 0.05), the rate of TIMI 3 grade was significantly less in intravenous administration group than intracoronary administration group(56.52% vs 75.51%)(P<0.05).LVEF was significantly lower in intravenous administration group than intracoronary administration group(54.19 ± 4.37)% vs(63.58 ± 4.52)%(P< 0.05),E / A > 1 was significantly less in intravenous administration group than intracoronary administration group(28.26% vs 53.06%)(P< 0.05),E / A ≤1 was significantly more in intravenous administration group than intracoronary administration group(71.74% vs 46.94%)(P< 0.05). There was no significant difference between the two groups in myocardial reinfarction, arrhythmia, angina, thrombocytopenia, death. Mild bleeding was significantly more in intravenous administration group than intracoronary administration group(21.74% vs 10.21%)(P<0.05).PLT and PAR were significantly higher before administration than after administration in both groups(P< 0.05).(2) Before administration,Baseline platelet reactivity had no significant difference in intracoronary group and intravenous administration group(64.33±5.98 vs 61.22±4.31)(P> 0.05); After administration, baseline platelet reactivity had no significant difference in intracoronary groups and intravenous administration group(63.78±4.49 vs 62.35±2.76)(P> 0.05). In intracoronary group, baseline platelet reactivity had no significant difference between before administration and after administration(63.33±5.98 vs 63.78±4.49)(P> 0.05).In intravenous group,baseline platelet reactivity had no significant difference between before administration and after administration(61.22±4.31 vs 62.35±2.76)(P> 0.05).In the intravenous group, residual platelet reactivity was significantly higher after administration for 10 min than before administration(48.44±10.21 vs 42.85±13.22)(P<0.05); In the intracoronary group, residual platelet reactivity was significantly higher after administration for 10 min than before administration(55.188±9.67 vs 43.26±11.53)(P<0.05). Residual platelet reactivity in intracoronary groups was significantly higher than intravenous administration group after administration for 10 min(55.18±9.67 vs 48.84±10.21)(P<0.05). Platelet aggregation rate has no significant difference between two group before administratio(46.58±6.39 vs 47.26±6.55)(P> 0.05).Platelet aggregation rate was significantly lower in intracoronary groups than intravenous administration group after administration for 10 min(6.33±1.39 vs 13.84±2.45)(P <0.05).Platelet aggregation rate was significantly lower in intracoronary groups after administration for 10 min than the previous administration(6.33±1.39 vs 46.58±6.39)(P <0.05).Platelet aggregation rate was significantly lower in intravenous groups after administration for 10 min than the previous administration(13.84±2.45 vs 47.26±6.55)(P <0.05).(3) Before administration,there was no significant difference in platelet CD40 L expression in intravenous groups and intracoronary groups(32.66±6.27 vs 34.19±5.17)(P>0.05).Platelet CD40 L expression in intracoronary groups was significantly lower than intravenous groups after administration for 36 hours55.09±6.33 vs 78.22±7.08)(P <0.05).Platelet CD40 L expression after administration for 36 hours was significantly higher than the previous administrationin intracoronary groups(55.09±6.33 vs 34.19±5.17)(P<0.05).Platelet CD40 L expression was significantly higher in intravenous groups after administration for 36 hours than previous administration(78.22±7.08 vs 32.66±6.27)(P <0.05).Previous administration,There was no significant difference in s CD40 L expression between intravenous groups and intracoronary groups(29.13±4.28 vs 30.06±3.79)(P <0.05).After administration for 36 hours,s CD40 L expression was significantly lower in intracoronary groups than intravenous group(51.28±8.41 vs 69.19±7.33)(P <0.05).In intracoronary groups,s CD40 L expression was significantly higher after administration for 36 hours than the previous administration(51.28±8.41 vs 30.06±3.79)(P <0.05).In intravenous groups,s CD40 L expression was significantly higher after administration for 36 hours than the previous administration(69.19±7.33 vs 29.13±4.28)(P <0.05).Previous administration,There was no significant difference in MMP-2 expression between intravenous groups and intracoronary groups(0.45±0.17 vs 0.46±0.11)(P>0.05).After administration for 36 hours, MMP-2 expression was significantly lower in intracoronary groups than intravenous groups(0.55±0.14 vs 0.71±0.09)(P <0.05). In intracoronary groups, MMP-2 expression was significantly higher after administration for 36 hours than the previous administration(0.55±0.14 vs 0.46±0.11)(P <0.05),in intravenous groups, MMP-2 expression was significantly higher after administration for 36 hours than the previous administration(0.71±0.09 vs 0.45±0.17)(P <0.05).Conclusion(1) Tirofiban intracoronary administration was better than intravenous administration in improving TIMI grade and heart function in patients with acute myocardial infarction undergoing PCI treatment. and it has better security, no increasing the risk of major bleeding.(2) Tirofiban can effectively reduce the vessel "no-reflow" rate after PCI. intracoronary infusion of tirofiban was superior to intravenous injection.(3) Intracoronary infusion of tirofiban are better to prevent thrombosis in patients with acute myocardial infarction undergoing PCI treatment. |
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