Effects Of Intracoronary Tirofiban Before Or After The Coronary Opened On Myocardial Reperfusion In STEMI Patients Undergoing Primary PCI

Objective:1To study Thrombolysis In Myocardial Infarction（TIMI) grade, STsegment resolution（STR）postoperative90mints, discussing the influence ofintraoperative or postoperative coronary flow and myocardial microcirculationperfusion by intracoronary injecting the glycoprotein Ⅱb/Ⅲ a receptorinhibitor (Tirofiban) in different timing in patients with acute ST-segmentelevation myocardial infarction (STEMI) undergoing primary percutaneouscoronary intervention(PPCI).2To study the short-term outcome of intracoronary injection Tirofiban indifferent timing during PPCI by the incidence rate of Major AdverseCardiovascular Events (MACE, include cardiac death，Nonfatal myocardialinfarction, Recurrent angina and again revascularization) during hospitali-zation and follow-up within90days.3To assess safety of intracoronary injection Tirofiban therapy duringPPCI in patients with STEMI.Methods：1Patients: From January2013to December2013, according the ChineseMedical Society of Cardiology criteria of STEMI in2010, a total of80patients with acute STMI were enrolled in this study. Randomly divided intotwo treatment groups, of which the experimental group (intracoronaryTirofiban before the first coronary balloon angioplasty) had42cases,25cases(59.5%) of men, with an average age of58.12+/-9.12years old. Control group(intracoronary Tirofiban after the coronary balloon angioplasty) had38cases,22cases (57.9%) of men, with an average age of58.95+/-8.66years old.2Treatment: All of patients from two groups were given oral aspirin300mg, clopidogrel600mg and atorvastatin40mg before primary PCI. In experimentalgroup，hydrochloric Tirofiban in dose of10ug/kg was intracoronary injectedafter the guide-wire crossing and before the first balloon expanding the lesions.In the control group，intracoronary Tirofiban in dose of10ug/kg was injectedafter guide-wire crossing the lesions, the IRA completely opened by balloonexpanding. Meanwhile, all patients maintenance intravenous infusion at0.10ug/(kg·min) for24hours. After PCI, all patients were managed withonce-daily dose of aspirin (100mg), clopidogrel (75mg) and atorvastatin(20mg). Subcutaneous low-molecular heparin (4250units, q12h) wasadministered for7days. A B-blocker, a nitrate and an angiotensin-convertingenzyme inhibitor (ACEI) were also routinely prescribed to the patients afterthe PCI if there was no contraindication.3PCI: According the methord of PCI, used Judkins way to completecoronary angiography then confirm the infarction related artery（IRA），afterthe drugs treatment，began to angioplasty or implant stenting only in theinfarct-related coronary arteries.4Statistical Analyse: all the date was analysis by the SPSS20.0software.The measurement data was expressed with mean+/-standard deviation,differences between measurement data of two groups were compared by t-test;Enumeration data by percentage expressed was compared by chi-square test;The TIMI flow classification after PCI using rank and inspection. Differencewas considered statistically significant with P<0.05Results:1There were no significant differences between the two groups in routineclinical features, risk factors (hypertension, diabetes, hyperlipidemia)，the doorto balloon time, number of vessels diseased, infarct-related artery types, thenumber of the number of post-dilatation, the number of stents（P>0.05）.2The infarct-related artery of those selected80patients was successful-ly reopened. Two groups of patients after the stent implantation IRA forwardflow reaches TIMI grade three,40cases in the experimental group (95.2%),32cases in the control group(84.2%).Compared with the control group, the experimental group showed a lower ratio of no-reflow phenomenon (4.8%vs.15.8%, P=0.049). The STR after PCI in the experimental group is much higherthan the control group (P<0.05).Those date indicated that intracoronaryTirofiban after the CAG before the first coronary balloon angioplasty maybehelpful for myocardial re-perfusion.3There were no significant different of the incidence rate of MACE duringhospitalization and follow-up within90days (P>0.05).4There were no difference in bleeding between two groups (P>0.05).Conclusion:For emergency PCI patients with confirmed acute STEMI, application ofhydrochloric Tirofiban before the first coronary balloon angioplasty, whichcan improve the myocardial reperfusion to some extent reduce the incidenceof no-reflow phenomenon,without increasing hemorrhage and the incidencerate of MACE in hospitalization and follow-up of90days．...