Effects Of Tirofiban On The SOX40L And Strain Rate In Patients With Coronary Heart Disease After Stent Treatment

Objective: To investigate the relevance between sOX40L and coronary heart disease (CHD) and the relationship of sOX40L concentration with the severity of CHD and other established cardiovascular risk factors, And observe the sOX40L concentration and Strain rate (SR)changes after stent and tirofiban treatment.Method: Coronary angiography (CAG) was performed in 85 hospitalized patients who were suspected as having coronary heart disease. The severity of pathological changes of the coronary artery was assessed by the number of diseased coronary branches and Gensini's score. According to the results of CAG, 85 patients were divided into 2 groups: CHD group (cases, n =60) and non-CHD group (controls, n = 25). The CHD group patients were further divided into subgroups according to the clinical types, the number of diseased coronary branches and Gensini′s score. The Strain rate (SR) was obtained by Strain rate imaging(SRI) ,The plasma sOX40L concentration, Fibrinogen (Fbg), high sensitive C-reactive protein (hs-CRP), white blood cell (WBC) count, lipids, blood pressure, body mass index (BMI), serum glucosis (SG) were measured before medication and CAG, The plasma sOX40L concentration and Strain rate (SR) after stent and tirofiban treatment was observed in different days. sOX40L,WBC and hs-CRP were compared statistically between the subgroups, and spearman correlation coefficients (rp) of sOX40L with hs-CRP and other cardiovascular risk factors were calculated.Result: (1). Plasma sOX40L concentration in CHD patients was significantly higher than that in controls (P<0.01). The plasma sOX40L concentration in myocardial infarction(MI) subgroup and unstable angina pectoris (UA) subgroup was significantly higher than that in the stable angina pectoris (SA)subgroup (P < 0.01). Also the plasma sOX40L concentration in MI subgroup was significantly higher than that in UA subgroup. (2).sOX40L concentration increased with the increasing number of diseased coronary branches and Gensini′s score respactively. Stastistical variance was observed among different subgroups (P<0.01). (3).Plasma sOX40L concentration was positively correlated with hs-CRP(rp=0.526,P<0.01)and LDL-C level(rp=0.589, P<0.01), and was negatively correlated with HDL-C(rp =-0.442,P<0.01), and was not association with triglyeride (TG), Fbg, total cholesterol(TC), BMI, WBC, age etc.(P>0.05). (4).In stent group,The plasma sOX40L concentration after stent treatment immediately,24h and 36h got even more higher than that before PCI(P<0.01). The plasma sOX40L concentration after PCI 10 days was significantly lower than pre-stent treatment, but was still to remain significantly higher than controls(P<0.01). But in tirofiban group, The plasma sOX40L concentration after PCI immediately,24h and 36h was significantly lower than that of stent group(P<0.01), No significant difference was found in sOX40L concentration between tirofiban group and controls after PCI 10 days. (5) Compared with normal myocardium, the peaks of strain rate curve at systole, early diastole and late diastole of ischemic myocardium all reduced, the postsystolic shortening( PSS) wave appeared before PCI operation. Each peak of strain rate curve increased gradually and PSSwave disappeared after stent and tirofiban treatment.(6)During stay at hospital and after discharge from hospital one month,there were no occurrence of major adverse cardiac events, thrombocytopenia and severe bleeding complications in both stent group and the stent + Tirofiban group, but in stent + Tirofiban group, the cases of mild bleeding were slightly more than that in the stent group.Conclution: (1).Plasma sOX40L concentration in CHD patients was higher obviously than controls. (2).The severity of coronary atherosclerosis can be reflected by plasma sOX40L concentration. (3). PCI treatment possibly can induce increasing of sOX40L concentration, which perhaps contributes to inflammatory reaction process promoted by stent. Tirofiban treatment may reduce plasma sOX40L concentration. (4). sOX40L was positively correlated with hs-CRP and LDL-C , negatively correlated with HDL-C, and was not association with Age,TG,Fbg,BMI,WBC.(5). SRI can accurately differentiate abnormal perfusion segments from normal ones. Stent and tirofiban treatment can significantly improve the blood supply to the ischemia myocardium and recover the function of myocardial deformation.(6) The application of tirofiban in coronary artery is safe, effective and feasible during PCI.