| Objective: In this randomized study, we observed the influence of tirofiban on the c-reactive protein. p-selectin and creatine kinase-MB (CK-MB). cardiac troponin (cTnI) in patients with acute myocardial infarction after percutanous coronary intervention (PCI).Methods: From December 2007 to December 2007, 97 cases(57 male and 40 female, age 67.35±10.25 years )who hospitalized in our department and received selective PCI were enrolled in our study. All the patients losed the chance of thrombolysis and acute PCI because of missing the best time. All patients enrrolled had persistent angina for more than 30 minutes and the cardiac enzyme peak beyond two folds of normal range and troponin positive and / or ECG showed ST segment elevation beyond 2 leads or new left bandle branch block. These 97 cases were randomly divided into two groups which were the tirofiban group (n=50) and the control group (n=47). Before 0.5 hours of operation, We gave tirofiban (10μg/kg over 3 minutes as load dose, followed by 0.15μg/kg/min administration mainting 24h) in the tirofiban group. Before the PCI, we used enough clopidogrel, aspirin and low molecular heparin in both groups. The platelet aggregation was controlled about 40 percent. During the PCI, we only touch the IRA. In each group, we collected clinical information detailedly, including: age, gender, body mass index, smoking, drinking, diabetes, lipids, location of AMI, medication, cardiac function and distribution of lesions, stent type, etc. the patients who were not suitable for PCI exited the study. The patients with diabetes all recepted insulin. Peripheral blood samples were drawn 1h before PCI and 30min, 2h, 6h, 24h after PCI, CRP, P-selectin and CK-MB, cTnI were measured. We used SPSS11.5 for Windows statistics software to analysis all of the data. The variables were presented as the means and the SD. Differences between group means were assessed with the t test. TheΧ2 analysis or the Fisher exact test was used to test differences between proportions. Statistical significance was indicated by p value <0.05.Results: There was no significant differences about age, gender, body mass index, smoking, drinking, diabetes, lipids, location of AMI , medication, cardiac function and distribution of lesions, stent type between the two groups. Four patients were not suitable for PCI, so they exited the study. The p-selection level of the control group after PCI in 0.5h, 2h was significantly higher than it before the operation(8.17±2.44 vs 5.08±1.40%; 6.02±1.64 vs 5.08±1.40%, p<0.05 ) ; The p-selection level of the tirofiban group after PCI in 0.5h, 2h, 6h was lower than it in the control group(5.49±1.23 vs 8.17±2.44%; 4.69±1.17 vs 6.02±1.64%; 4.59±1.06 vs 5.09±1.22%, p<0.05). The CRP level 0f the control group after PCI in 6h, 24h was significantly higher than it before the operation(2.88±0.97 vs 1.95±0.93mg/dl; 3.49±0.19 vs 1.95±0.93mg/dl, p<0.05), The CRP level of the tirofiban group after PCI in every time was lower than it in the the control group ( 1.65±0.75 vs 2.09±0.94mg/dl; 1.85±0.84 vs 2.23±0.87mg/dl; 2.23±0.95 vs 2.88±0.97mg/dl; 2.71±0.86 vs 3.49±0.19mg/dl, p<0.05). The CK-MB level was no different between the two groups. The cTnI level of the control group after PCI in 6h, 24h was significantly higher than it before the operation (1.94±0.30 vs 1.82±0.23ng/ml; 2.52±0.39 vs 1.82±0.23ng/ml, p<0.05).The cTnI level of the tirofiban group after PCI in 6h, 24h was lower than it in the control group(1.82±0.21 vs 1.94±0.30ng/ml; 1.84±0.19 vs 2.52±0.39ng/ml, p<0.05). There was no significant difference in hemorrhage events between the two groups.Conclusion: The P-selectin and CRP significantly increased after PCI, suggesting that PCI may be further activated a series of inflammatory immune response, it may be related to the acute stent thrombosis happening after operation. Tirofiban can reduce the level of P-selectin, CRP after PCI, inhibit inflammatory response, reduce acute stent thrombosis happening. The cTnI elevated significantly after PCI, suggesting that PCI may cause myocardial damage, tirofiban can improve the no-reflow, further reduce myocardial injury.
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