The Efficacy And Safety Of Tirofiban In Patients With Unstable Angina Pectoris Before Percutaneous Coronary Intervention

Objective: To evaluate the efficacy and safety of the intravenousapplication of Tirofiban in patients with unstable angina pectoris beforepercutaneous coronary intervention.Methods: From Apr2011to May2012, a total of194patients withunstable angina pectoris from Cardiology Department of Tangshan GongrenHospital affiliated to Hebei Medical University were enrolled in this study.The patients were randomly divided into three groups before percutaneouscoronary intervention (PCI). The Tirofiban were applied to65patients withunstable angina pectoris before PCI (Tirofiban group), when64patients weretreated by Tirofiban after PCI (Directly PCI group) and65patients weretreated by PCI without Tirofiban (Control group).All patients were accorded with the diagnostic standard constituted bycardiovascular branch of Chinese Medical Association:(1)The character oforiginal stable type angina pectoris changed, including episodes frequently,severity increased or the duration prolonged;(2)The paroxysm of anginapectoris induced by a slight physical activity in the past1months;(3)Theparoxysm of angina pectoris during rest;(4)The electrocardiogram shows achange in ST-T (2or more leads were related), and myocardial infarction wasexcluded by the myocardial enzyme spectrum and electrocardiogramexamination. Exclusion criteria:(1)The angiography showed that the stenosisof coronary artery less than70%;(2)The severe congestive heart failure orcardiogenic shock;(3)With the situation that active bleeding or hemorrhagictendency, platelet count of less than80×109/L or associated with plateletdysfunction and had cerebrovascular events in the past year;(4)Patients wereallergic to Tirofiban;(5)The blood pressure increased continually with systolicblood pressure180mmHg and(or) diastolic blood pressure more than 110mmHg;(6)Had a trauma in the past2weeks or a long time (more than10min) CPR history or hepatosis and nephric dysfunction;(7)The coronaryangiography showed pathological changes in left coronary artery.Tirofiban were applied through intravenous injection for patients ofTirofiban group before PCI. The initial loading dose was10ug/kg whichrequire injection in3min, followed by durative intravenous pumping with0.15ug/(kg.min) until36hours after PCI. The dose of Tirofiban was half inpatients over75years old or with renal inadequacy. There was no applicationof Tirofiban in patients of Directly PCI group before PCI, but the applicationof Tirofiban after PCI was uniformity. There was no application of Tirofibanin patients of Control group. Aspirin300mg and Clopidogrel Bisulfate Tablets300mg were given to all patients before PCI. Normal heparin500-1000U weregiven to all patients every hour through durative intravenous pumping until theday after PCI, and the low molecular weight heparin were applied durativelythrough subcutaneous injection5~7d after that. Aspirin100mg should betaken orally one times every day for life, and Clopidogrel Bisulfate Tablets75mg should be taken orally one times every day for12months. Nitrates,statins, ACEI and β receptor blocking agent were applied according to thecondition of patients.We compared instant postoperative TIMI flow grade, corrected TIMIframe count (CTFC), the bleeding conditions duration of hospital stay, the rateof thrombocytopenia and major adverse cardiac events (MACE)(includingcardiac death, non-fatal myocardial infarction, repeate revascularization,recurrent angina pectoris and so on). The follow-up period was6months, andthe incidence rate of MACE was observed6months later after PCI. Themeasurement data are presented as mean±standard deviation, and enumerationdata were expressed as a percentage. All data were analyzed by SPSS13.0statistical software by F test, chi-squared test, Fisher probabilities or partitionsof X~2method. A two-tailed P<0.05or P<0.0167was considered as statisticallysignificant.Results: The difference between general materials of the three groups had no statistical significance, including age, sex, smoking, hypertension,diabetes, hyperlipidemia, the type of stent, the number of stent, the diameter ofstent, the length of stent, the implantation site of stent, the time of opertion thesuccessful rate of PCI (P>0.05). The proportion of patients in Tirofiban proupwith TIMI flow grade3after PCI (95.38%) exceeded that in Directly PCIgroup (81.25%) and Control group (80.00%), and the difference wasstatistically significant (P<0.0167). The difference between Directly PCIgroup and Control group had no statistical significance (P>0.0167). Theproportion of patients with the corrected TIMI frame count less than27afterPCI in Tirofiban proup was73.85%, when it was53.13%in Directly PCIgroup and50.77%in Control group and the difference had statisticalsignificance (P<0.0167). The difference between Directly PCI group andControl group had no statistical significance (P>0.0167). There are5cases ofbleeding conditions in Tirofiban group,3cases in Directly PCI group and onecases in Control group. The difference of bleeding events incidence betweenthe three groups had no statistical significance (P>0.05). There was one caseof thrombocytopenia in Tirofiban group, but with no bleeding tendency andthe platelet count recovered when stop using Tirofiban. During hospitalization,one patients in Tirofiban group had recurrent angina pectoris and the quantityin Directly PCI group was3, when that was8in Control group. The incidenceof MACE in Tirofiban group was1.54%, when the incidence was12.31%inControl group and4.69%in Directly PCI group. The difference betweenTirofiban group and Control group had statistical significance (P<0.0167). Nocases of patients were lost after6months of follow-up, the results wassatisfactory. After6months, the incidence of MACE in Tirofiban group was6.15%, when the incidence was21.54%in Control group and9.38%inDirectly PCI group. The incidence of MACE in Tirofiban group was less thanthat in Control group, and the difference had statistical significance(P<0.0167). The incidence of MACE after6months follow-up were similarbetween the other groups (P>0.0167). Conclusion:1The intravenous application of Tirofiban in patients with unstableangina pectoris before PCI can increase the blood perfusion of TIMI andimprove blood supply in myocardium.2The application of Tirofiban in patients with unstable angina pectorisbefore PCI can reduce the postoperative incidence of angina pectoris andMACE，and it can improve patient’s recent outcome.3The Tirofiban won’t increase the risk of bleeding complications andthrombocytopenia, neither it’s applied in patients with unstable angina pectorisbefore PCI nor after PCI.