The Impacts Of Difflerent Interventional Protocols On Recent Outcomes In No-reflow Patients With STEMI

Objective To compare of thrombus aspiration (thrombus aspiration) and platelet glycoprotein (glycoprotein, GP)Ⅱb/Ⅲa receptor antagonist-tirofiban in patients with acute ST-segment elevation myocardial infarction (STEMI) with no reflow in the primary percutaneous coronary intervention (PPCI) procedures for different applications by postoperative myocardial perfusion, cardiac markers, TXA2, ET-1levels and prognosis.Methods Consecutive selected a total of127cases with STEMI in our hospital from January2008to December2011which is divided into two groups according to the different methods treated thrombosis during the course of PPCI:thrombus aspiration group (TA group, n=55), thrombus aspiration+tirofiban (TAT group, n=72). After the operation each group was compared thrombolysis in myocardial infarction (TIMI) flow grade, TIMI myocardial perfusion (TMP) grade,50%ST segment drop after1hour, Creatine kinase enzyme(CK-MB), troponin I (cTnⅠ) peak and the peak time, comparison of the different of neutrophil ratio, TXA2and ET-1levels after the procedures, the major adverse cardiovascular events (MACE) during hospitalization and out of hospital.Results1. Compared with the TAT group and TA group blood perfusion of TIMI3level was significantly increased (88.9%vs69.1%, P<0.05). The proportion of patients with myocardial perfusion grade TMP3also significantly increased in the thrombus aspiration+tirofiban group (84.7%vs76.4%, P<0.05), the proportion of patients with no-reflow TMP0-1level significantly reduced (2.8%vs10.9%, P<0.05).2. Compared with the TAT group and TA group, the proportion of patients with50%ST-segment resolution after1hour were higher (52.8%vs36.4%, P<0.05), CK-MB peak reduced (167.8±81.4vs285.6±69.1, P<0.05), cTnⅠ peak decreased (36.9±28.2vs52.2±42.3, P<0.05), CK-MB peak time (9.1±6.8vs13.1±5.3, P<0.05) and cTn1peak time advanced (10.1±6.2vs14.5±8.5, P<0.05), the difference was significance.3. Compared with the TAT group and TA group the neutrophil ratio were reduced (19.90±7.85vs10.69±2.42, P<0.05) and TXA2(6.1±2.58vs3.2±1.12, P<0.05), ET-1(5.2±1.4vs4.1±1.42P<0.05) levels were declined, the difference was statistically significant (P<0.05).4. During hospitalization, compared with the TAT group and TA group the incidence of MACE was decreasing, but not statistically significant (P>0.05).5. Follow-up1.80±0.4years, compared with the TAT group and TA group, MACE were reduced, but the difference was not significant (P>0.05).Conclusion The use of the thrombus aspiration technology and Ⅱ b/Ⅲa receptor antagonist-tirofiban during PPCI in patients with acute myocardial infarction accompanied by no-reflow can reduce the thrombus load, increase the level of myocardial perfusion immediately after procedures, and improve recent clinical outcomes. Applying thrombus aspiration+tirofiban technology can further reduce microvascular thrombosis and embolism, inhibit inflammation, reduce the levels of TXA2and ET-1, avoid further damage of microcirculation and myocardium, improve recent clinical outcomes.