Evaluation On Safety And Efficacy Of Tirofiban Combined With Heparin In Patients With Acute Myocardial Infarction Undergoing Emergency Percutaneous Coronary Intervention

Objective To study the clinical efficacy and safety of half dose tirofiban combinedwith heparin in patients with acute myocardial infarction receiving the primarypercutaneous coronary intervention (PPCI).Methods1.Case selection and grouping：Collect patients with acute ST-segment elevationmyocardial infarction receiving emergency coronary intervention from May2011toJanuary2013in the People’s Hospital of Liaoning Province. All patients were in linewith WHO principle of acute myocardial infarction and Emergency Interventionalindications. According to the results of coronary angiography, a total of95patientswith STEMI treated with primary PCI were randomised to2groups：Full dose group:the full dose tirofiban+70IU/kg heparin; half dose group: half dose tirofiban+100IU/kg heparin. The mean age of full dose group was53.42±50years old, the mean ageof half dose group was49.57±11.68years old.2. Ways and means of administration:Two groups were routinely given Aspirin300mg, Chlorine Clopidogrel300mg, Atorvastatin40mg orally before Coronaryangiography. Full dose group were given70iu/kg heparin by Intravenous injection, anda loading dose of tirofiban10ug/kg injection in3minutes, followed by infusion at a rateof0.15ug/(kg min) pump for36hours. Half dose group were given100iu/kg heparinby Intravenous injection, and a loading dose of tirofiban10ug/kg injection in3minutes,followed by infusion at a rate of0.075ug/(kg·min) pump for36hours. Usefondaparinux the hepatic sodium decanoate by2.5mg/d subcutaneous injectionPostoperative36hours. At the same time, two groups were routinely given Aspirin100mg/d, Chlorine Clopidogrel75mg/d, Atorvastatin20mg/d, bisoprolol2.5mg/d and nitric acid lipid drug therapy.3. Percutaneous coronary intervention：All patients were received percutaneouscoronary stent implantation within12hours by an experienced physician.4. Outcome measures：The indicators included the thrombolysis in myocardialinfarction trial flow grade (Thrombolysis In Myocardial Infarction，TIMI)，Myocardialperfusion level (TIMI myocardial perfusion grading, TMPG), The corrected TIMI flowframes meter (Corrected TIMI Frame Count, CTFC),2hours ST segment elevation,Platelet aggregation, EF value after one week, Bleeding, and MACE events duringhospitalization.5. Data processing：All data was analyzed with spss13.0．Measurement data wasanalyzed by t test, categorical variables was analyzed by chi-squared test or Fishertest． Data was presented as mean standard deviation(SD)． The difference wasconsidered significant with P <0.05.Result1. There was no difference in gender, age, hypertension, diabetes, high cholesterol,smoking, alcohol consumption, BMI, and other basic information between the twogroups (p>0.05).2. Coronary angiography results of two groups： There was no difference inPostoperative TIMI flow grade3between two groups（86.0%VS82.2%,P=0.614）;There was no difference in postoperative TMP flow grade3between two group（s74.0%VS71.1%,P=0.753）; the CTFC count between two groups was not statisticallysignificant difference (29.65±4.53VS30.80±3.42，P=0.674);3. Comparison of two sets of clinical data：There was no statistically significantdifference for two hours after ST≥50%ratios (90.0%VS88.9%,P=0.860）；EF valuesof the two groups was no significant difference (0.51±0.06VS0.49±0.06，P=0.583).4. Cardiovascular events during hospitalization： one was dead duringhospitalization, died of cardiogenic shock in full dose group; targeting vascularreconstruction in full dose group was zero, was one in half dose of group, there was nodifference between two groups(P>0.05).5. TIMI bleeding rates of the two groups were significantly different (p <0.05);The incidence of thrombocytopenia and main hospital MACE events duringhospitalization was no significant difference (p>0.05).6. hospitalization costs of Two groups patients(35988yuan±6580.93VS33629±4174.04yuan,P=0.042) and hospital stay （8.54±2.59days VS7.84±2.81days, P=0.544）.Conclusion1. There was no difference in improving coronary blood flow between the twogroups.2. The incidence of major cardiovascular events(MACE) and thrombocytopenia inthe two groups within hospitalization was not significantly different.3. Compared with full dose group, shemorrhagic complications of half dose groupwas low, and saved hospital costs.