| Objective1.To evaluate the effect of glycoproteinⅡb/Ⅲa receptor blockade (Tirofiban)on coronary flow and myocardial blush perfusion recovery in patients with acute myocardial infarction treated by primary percutaneous coronary intervention by analyzing TIMI(Thrombolysis In Myocardial Infarction)flow,CTFC(Corrected TIMI frame count),MBG(Myocardial blush grades,MBG),STR(ST segment resolution).2.To investigate the short-term efficacy of Tirofiban therapy in patients with acute myocardial infarction undergoing primary PCI by observing LVEF (Left ventricular ejection fraction)and the incidence of in-hospital and 6 month follow-up MACE.3.To investigate safety of Tirofiban therapy in patients with acute myocardial infarction undergoing primary PCI.Methods1.Characters of all subjects:90 cases with acute myocardial infarction who were performed primary percutaneous coronary intervention between October.2005 to October.2006 were selected,were randomized into groups of Tirofiban(n=45)and group of control(n=45).2.Drug therapy:All patients received aspirin 300mg before the procedure and continued 100mg/d,clopidogrel 300mg and 75 mg/day afterwards for at least 12 months and LMWH Q12h for 5 days after PCI.The tirofiban group was administered 1 intravenous bolus Tirofiban of 10μg/ kg before PCI in 3min followed by infusion at a rate of 0.15μg/kg/min through pump to 24h. All patients in the two groups took Satin,Betaloc,ACEI and Nitrate conventionally.3.PCI:All patients were undergone standard CAG to identify the IRA (Infarction related artery)and stents were implanted to IRA..4.Study end points:TIMI grade,CTFC,MBG,STR were studied immediately after PCI.Baseline characteristics,TIMI grade,CTFC,MBG of the two groups were compared.Incidence of in-hospital and 6 month follow-up MACE and adverse drug effect were observed in both groups.5.Statistic analysis:Data were analyzed with use of SPSS 11.5. Continuous variables were compared by t test.Categorical variables were compared by chi-squared test or Fisher test.Data are presented as mean±standard deviation(SD).A two-tailed P＜0.05 was considered as statistically significant.Results1.There was no significant difference between the two groups in baseline characteristics,including age,Drug therapy,IRA distribution(P＞0.05).2.The rate of reperfusion of the two groups has no significant difference(100%vs 97.78%,P＞0.05).The percentage of TIMI3 flow achieved has no significant difference in IRAs after PCI(95.56%vs88.89%,P＞0.05). However,fewer corrected TIMI frames(22.80±5.14 vs 28.58±4.55,P＜0.01) and higher percentage of MBG3(68.89%vs44.44%,P＜0.05)of IRAs were achieved in tirofiban group.3.There was no significant difference in the occurrence of MACE during hospitalization between the two groups(0%vs2.22%,P＞0.05).The 6 month incidences of major adverse cardiac events were 11.1%in the Tirofiban group and 17.78%in the control group(P＞0.05).4.During hospitalization,no episodes of major bleeding or severe thrombocytopenia and no need for red blood cell transfusions were observed. The minor bleeding rate was higher in patients treated with tirofiban,but this difference was not statistically sign- ificant(11.1%vs2.22%,P＞0.05)Conclusions 1.Application of tirofiban during primary PCI in patients with acute myocardial infarction can improves coronary flow and myocardial perfusion.2.The incidence of MACE during in-hospital and short-term follow-up have downtrend in the tirofiban group.3.Tirofiban therapy in patients with acute myocardial infarction undergoing primary PCI is safe,without significantly increase the adverse drug effects,such as bleeding or platelet reduction.
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