| Objective:(1) To investigate the effects of different administration route of tirofiban on plateletaggregation rate (PAR) by measuring PAR before administration and after intracoronary orintravenous application of tirofiban10minutes later of the patients with acute myocardialinfarction (AMI) who receive direct percutaneous coronary intervention (PCI) treatment.(2) To evaluate the efficacy of intracoronary application of tirofiban around canalizinginfarction related artery (IRA) in the patients with AMI during direct PCI by observingpostoperative bloodstream, left ventricular ejection fraction (LVEF) and the incidents of majoradverse cardiac event (MACE).(3) To evaluate the security of intracoronary application of tirofiban around canalizingIRA during direct PCI treatment.Methods:(1) Object of study:62patients with AMI who receive direct PCI treatment wereresearched during2011and divided into two groups: intracoronary group (intracoronaryapplication of tirofiban both before and after canalizing IRA, n=31) and intravenous group(intravenous custom application of tirofiban before canalizing IRA, n=31).(2)Medication: All patients received aspirin300mg and clopidogrel300mg before theoperation, made clear IRA by coronary angiography, tirofiban was applied after seal wire orballoon through pathological changes, intracoronary group was injected tirofiban0.5mg (10ml)at twice in coronary artery around canalizing IRA, then followed by infusion at a rate of0.15μg/(kg·min) through pump to24h~48h; intravenous group was injected tirofiban loading dose(10μg/kg) in peripheral vein in2minutes, then followed by infusion at a rate of0.15μg/(kg·min) through pump to24h~48h.(3) Drew blood in coronary artery before administration and after administration, turbidimetry was used to measure PAR, revulsant was ADP, and interrelated clinical indexeswere also observed.(4) Statistic analysis：Data were analyzed by the SPSS17.0for windows. Continuousvariables were presented as mean±standard deviation (SD) and compared by t test. Categoricalvariables were compared by chi-squared test. P<0.05was considered to be statisticallysignificant.Results:(1) There was no significant difference between two groups in general clinical data,including age, sex and risk factor.(2) Determination of PAR: in intracoronary group was57.77±15.64, in intravenous groupwas57.50±12.86before administration. And after administration10minutes later inintracoronary group was3.10±3.27, in intravenous group was4.84±3.09. After administration,PAR decreased significantly compared with before administration in both groups (P<0.01), andthere was significant difference between intracoronary group and intravenous group afteradministration (P=0.035).(3) There were2patients didn’t achieve TIMI grade Ⅲ blood flow in intracoronarygroup, while7patients in intravenous group, the difference between two groups was notstatistically significant (P=0.071) though the percentage of TIMI grade Ⅲ blood flow inintracoronary group was higher than the other group. CTFC in intracoronary group was20.97±5.95, while in intravenous group was25.00±7.37, the difference between two groupswas statistically significant (P=0.021).(4) LVEF in intracoronary group was56.03±6.01, while in intravenous group was52.61±6.20, there was significant difference between two groups (P=0.031). There were4patients occurred post-infarction angina (PIA) in intracoronary group, while6patients inintravenous group, the difference between two groups was not statistically significant (P=0.490),and no patient occurred other MACE in both gruops.(5) Only3patients occurred gum bleeding in intracoronary group, while2patients in theother group, there was no significant difference between two groups (P=0.641). No patientoccurred serious hemorrhage, thrombocytopenia. Conclusion:(1) Both intracoronary and intravenous application of tirofiban before canalizing IRA caneffectively decrease PAR during direct PCI treatment, and comparing with intravenousapplication, the decreasement of PAR is more obvious in coronary artery by intracoronaryapplication.(2) Comparing with intravenous application of tirofiban, intracoronary application duringdirect PCI treatment can improve coronary blood flow and reperfusion of infarct region better,thus increase the success ratio of operation and improve prognosis..(3) No matter intracoronary or intravenous application of tirofiban during direct PCItreatment may not increase incidence rate of side effects of drug such as hemorrhage,thrombocytopenia. Both administration route are safe and effective. |
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