| Objective:(1).To study Thrombolysis In Myocardial Infarction(TIMI)grade,Corrected TIMI Lame count(cTFC),ST segment resolution(STR) influence of intracoronary injection of GPⅡ/Ⅲreceptor inhibitor (tirofiban)in patients with STEMl before primary PCI.(2).to study the short outcome of ic tirofiban duiring PCI in STEMI by the LVEF of 7th and 4th days,the inhospital days and the Major adverse cardiac event(MACE).(3).to compare the CD40L ,SAA,VWF and p-seletinct in coronary sinus and artery before and after PCI, in order to evaluate the influence of endothelio function,thromboxane function and Inflammation by IC tirofiban.(4).to investigate safety of IC tirofiban therapy during PCI in STEMI.Methods:(1). Patients: according ACC/AHA criteria of STEMI in 2004,64 patients were enrolled in this study., divided into 3 groups,the group A was treatment with IC tirofiban(n=21),the group B was treatment with IV tirofiban(n=23),and the group C was treatment with IC undergoing (n=20).(2).treatment:Patients from all the groups were given oral aspirin 300mg and clopidogrel 600 mg before primary PCI. In all groups,the drug was administered after the completion of coronary angiography (CAG), but immediately before angioplasty or stenting of the infarct-related coronary arteries. In group A, tirofiban was administered as an intracoronary (10ug/kg over 3 min) followed by maintenance intravenous infusion at 0.15ug·kg-1·min-1 for 12 hours;In group B,tirofiban was given intravenously as a bolus (10ug/kg over 3 min) followed by maintenance intravenous infusion at 0.15ug·kg-1·min-1 for 12 hours. In group C,undergoing was administered as an intracoronary bolus 500000u over3min. After PCI, all patients were managed in the cardiac care unit with once-daily dose of aspirin (100 mg) and clopidogrel (75 mg). Subcutaneous unfractionated heparin (5,000 units, q12h) was administered for 3 days after the PCI. A B-blocker, a statin and an angiotensin-converting enzyme inhibitor (ACEI) were also routinely prescribed to the patients after the PCI if there was no contraindication.(3).PCI:according the methord of PCI,used Judkins way to confirm the Infarction related artery(IRA),after the drugs treatment,began to angioplasty or implant stenting in the infarct-related coronary arteries.(4).collect the serum specimen:all the serum specimen was taken from coronary sinus before and after PCI,then immediately taken to centrifugate in -40C and 3000rbp,and the keeping in -80 0C。(5).detect serum specimen:all the serum specimen were detected used the methord of euzymelinked immunosorbent assay(ELISA).(6). statistical analyse:all the dates was analysis by the SPSS16.0 software,enumeration data adoptχ2 test or Fisher fidelity test;and all the measurement data was tested by one-factor analysis of variance,the difference of statistical was define as (P<0.05.)Results:(1).there was no difference among the 3 groups in sex,age,height,weight,risk factors,information and baseline of IRA.(2).There were no different in CTFC before PCI among the 3 groups.The CTFC after PCI in all the groups were obviously decrease than before (P<0.05). The CTFC after PCI in group A were much lower than the group B and group C(P<0.05),but there no different between group B and group C(P>0.05).The TIMI grade before PCI had no difference among the 3 groups(P>0.05).The TIMI grade in the 3 groups were obviously improved after PCI than before ,but there was no difference among the the groups.(3).The STR after PCI in group A is much higher than Group C(P<0.05),also higher than group B,but there was no difference in statistical between the 2 groups.There were no difference between group B and group C(P>0.05).(4).There were no different in inhospital day,LVEF in the 7th day and MACE in 40days,but the LVEF in 40th day in group A is better than group B and group C(P<0.05.)(5).There were no difference in bleeding among the 3 groups(P>0.05).(6). The CD40L,SAA,p-selectin and vWF in coronary sinus in Group A after PCI is lower than before PCI (P<0.05),but had no difference in the other groups. Evenmore,The CD40L and SAA in group C were higher than before,but there iwas no difference in statistiction .All the serum factor in group A were lower than group C after PCI(P<0.05),it was also much lower in vWF and SAA than groupB(P<0.05),however there were no statistical difference in p-selectin and CD40L(P>0.05).There were no difference between group B and Group C in all serum factor after PCI(P>0.05)Conclusions:(1).Intracoronary tirofiban in patients with acute ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention can effectively improve cardiac microcirculation .(2).Although Intracoronary tirofiban before PCI did not reduce the MACE in 40days,but it can improve LVEF in 40days.(3).Intracoronary tirofibanin in patients with acute ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention is safity.(4). Tirofibanin may have the function of restraining the activation of platelet and release of inflammatory factor,and protecting the endothelium from injured,in witch more effectively by intracoronary administration,and this may improve long clinical outcome. |
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