| Objectives: To explore the effects of intracoronary administration ofanisodamine and tirofiban on myocardial perfusion in patients with acute STsegment elevation myocardial infarction （STEMI）and heavy thrombusburden.Methods: From March2012to December2013, a total of94patients ofSTEMI underwent primary PCI within12hours from the onset of chest painwere enrolled. The thrombus was confirmed in all above patients by coronaryangiography and those with thrombus score less than2were excluded. Allsubjects were well prepared with oxygen, electrocardiogram (ECG)monitoring as well as adequate anticoagulation and antithrombotic treatment.After coronary artery angiography (CAG), the corrected TIMI frame count(CTFC) of the culprit vessels were recorded, so as to evaluate coronarymicrocirculation. Then the patients were randomly assigned to receivetirofiban (group A, n=46) or anisodamine and tirofiban (group B, n=48). Forgroup A, tirofiban was intracoronary administered (10ug/kg,3min) into theinfarction related artery (IRA) and then was intravenously administered(0.0075ug/kg/min) for48hours. For patients in group B, besides the treatmentin group A, anisodamine was injected into IRA (60ug/kg,3min) and then wasintravenously administered (0.1-0.2ug/kg/min) for24hours. All patientsreceived drug-eluting stents by the standard of over75%of luminal stenosis.The hemodynamics were recorded3and5minutes respectively afterintracoronary administration of tirofiban with or without anisodamine, whileTIMI myocardial perfusion grade (TMPG) and corrected TIMI frame count(CTFC) of the culprit vessels were recorded5minutes after primarypercutaneous coronary intervention, to evaluate microcirculation perfusion. The peak of creatine kinase MB (CK-MB) was recorded. Left ventricularejection fraction (LVEF) and wall motion score (WMS) were calculated1week and1month later. These parameters above were used to evaluate thesize of myocardial infarction and ventricular function. The incidence ofreperfusion arrhythmia, hypotension and major adverse cardiac events(MACEs) including cardiac death, non-fatal reinfarction, severe heart failureand target vessel revascularization within the first month, were recorded toassess the effects of tirofiban combined with anisodamine on reperfusionarrhythmias, and clinical prognosis and its safety.Results: No significant differences were found with regard to baselineclinical characteristics, including age, gender, time from symptom onset toPCI, distribution of IRA and basic medications, etc (P>0.05).1The proportion of TIMI3in group B was higher than group A (47/48vs.39/46P=0.023). The TFC was decreased in group B than that in group A(24.43±3.98vs.30.19±9.47P<0.05). The proportion of TMPG3in group Bwas higher (81.3%vs.56.5%P=0.0009), compared with that in group A.2The intracoronary pressure，heart rate were increased significantly ingroup B than that in group A(P<0.05). The incidence of tachyarrhythmia inthe two groups was not significantly different (1/48vs.1/46P=0.976).On theother hand, the incidence of bradyarrhythmia and hypotension was decreasedstatistically in group B (1/48vs.6/46.2/48vs.8/46P all<0.05).3The peak value of CK-MB occurred earlier in group B than in group A(12.58±5.90vs.14.87±6.21, P=0.07), meanwhile, the peak value of CK-MBwas lower in group B than that in group A（209.0±110.3vs.289.5±173.2P=0.009).4No significant change was found between the two groups about LVEFand WMS1week after PCI (42.87±4.59vs.41.32±4.22.1.91±0.53vs.2.03±0.63P all>0.05).At the first month after PCI, these parameters were obviouslyimproved in group B than in group A(54.16±4.87vs.52.00±4.54.1.50±0.54vs.1.75±0.65P all <0.05).5The incidence of MACEs within the first month tended to decrease, but didn’t reach statistical significance (5.5%vs.6.9%P>0.05).Conclusions: Intracoronary administration of anisodamine and tiroftbancan increase the coronary perfusion pressure for the patients with STEMI andheavy thrombus burden, further prevent coronary microcirculation dysfunction,which in turn improve the heart function; and preventively reduce reperfusionbradyarrhythmia and hypotension; intracoronary administration of anisoda-mine and tiroftban tends to decrease the incidence of MACEs, but whichneeds further research．... |
PDF Full Text Request