| Background and Objective:Percutaneous coronary intervention(PCI) has became major means of coronary heart disease these years.Because it has been proved in many studies that drug-eluting stents(DES) can reduced rates of restenosis compared to bare-metal stent (BMS),they have been popularly used in clinical therapies.But DES causes substantial impairment in arterial healing characterized by lack of complete reendothelialization and persistence of fibrin for a long period of time,non-acute stent thrombosis(subacute thrombosis,late thrombosis and very late thrombosis)has emerged as a major concern with higher rates than BMS,especially late thrombosis. Stent thrombosis takes place in low rates,but it has serious and dangerious outcomes,such as myocardial infarction or death.It was showed in large scale studies that the application of antiplatelet treatment aspirin combined clopidogrol after PCI can decrease the rates of stent thrombosis and main adverse cardiac and cerebral event(MACCE).But there are still 10%rate of MACCE during the treatment with aspirin combined clopidogrol,the reason has been unkown at present,probably it was in relation to aspirin and(or) clopidogrol resistance.So it is important to study a kind of new therapy to prevent non-acute stent thrombosis after DES implantation.To prevent non-acute stent thrombosis after DES implantation,platelet glycoproteinⅡb/Ⅲa(GPⅡb/Ⅲa) blockade tirofiban combined warfarin,aspirin and clopidogrol were administrated in this study,and the safety and efficacy were observed.Methods:A total of 505 consecutive patients treated with PCI and DES implantation were invoved in this study from January 2005 to September 2008 in the seventh people's hospital of Zhengzhou city,and the patients must be implanted DES,and must be companied with one or more of such special characters as:≥2 stents,1 stent≥30mm,left main coronary artery,bifuration lesion with kissing ballons or kissing stents,ostial disease(left anterior descending after,right coronary,circumflex branch of left coronary artery),slow flow at PCI,and patients with diabetes.Patients in this study must be excluded with such characters as:Age≥75 years old,tendency of hemorrhage,malignant tumor and hypertention that can not be controlled under 160/100mmHg.All patients were randomly and parallelled divided into two groups: Group A(n=245) as observation group were treated with tirofiban,warfarin,aspirin and clopidogrol,and group B(n=260) as control group were treated with aspirin and clopidogrol.There were no differences in other treatments between the two groups. All of the clinical and angiographic and interventional treatment charaters were recorded.Stent thrombosis was adjudicated by the definition of Dublin for Academic Research Consortium(ARC).The risk of stent thrombosis was adjudicated by DES Real-world Incremental Value in the era of percutaneous revascularization score, (DERIVATION score).The MACCE,non-acute stent thrombosis,the adverse drug effects and bleeding of the two groups in hospital and after being discharged were recorded during follow-up every 1～3 months,and the rates of the MACCE, non-acute stent thrombosis,the adverse drug effects and bleeding between the two groups were compared respectively.Results:1.There were no differences in all of the clinical and angiographic and interventional treatment charaters between the two groups.In this study,45.47%of the total 505 patients were in medial risk of stent thrombosis adjudicated by DERIVATION score,and 39.80%were in high risk stent thrombosis.There were no significant differences in medial risk(41.22%vs.50.00%) and high risk(44.08%vs. 35.77%) of stent thrombosis between the two groups(all P＞0.05).2.The total rates of MACCE were significant lower in groupA than that in groupB at 12 months(0.82%vs.4.23%,P＜0.05),24months(1.54%vs.8.46%,P＜0.01),48 months(2.04%vs.10.77%,P＜0.01).and the rates of target vascular revasularization(TVR) in 13～24 months were significantly lower in groupA than that in groupB(0.41%vs.3.08%,P＜0.05).3.The rates of subacute stent thrombosis in group A is lower than group B,and there were were no significant differences in the rates of subacute stent thrombosis (0.41%vs.1.15%,P＞0.05) between the two groups,there were significant differences in the rates of late thrombosis(0 vs.2.31%,P＜0.05),and very late stent thrombosis(0.41%vs.3.08%P＜0.05) between group A and group B.4.There was 1(0.38%) case of major bleeding and 4(1.54%) cases of minor bleeding in group B,and 1 case of secondary bleeding and 8(3.27%) cases of minor bleeding in group A,the rates of minor bleeding in group A is higher than group B,but there was no significant difference between the two groups(3.27%vs.1.54%,P＞0.05).No significant differences in other adverse drug effects were observed between the two groups(all P＞0.05).Conclusions:The results indicated that GPⅡb/Ⅲa blockade tirofiban combined warfarin,aspirin and clopidogrol could reduce the rates of MACCE,decrease the rates of TVR,and it could prevent non-acute stent thrombosis after DES safely and effectively. |
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