Effect Of Intracoronary Injections Of Tirofiban On Treatment And Endothelial Function In Patients With Acute Myocardial Infarction During Percutaneous Coronary Intervention

Objective To evaluate ST-segement elevation myocardial infarction (STEMI) inpatients with primary percutaneous coronary intervention (PCI) intracoronary of tirofiban forthe clinical effect，before and after PCI,changes of von willebrand factor (vWF) on thethrombolysis in myocardial infarction (TIMI) flow.Methods84patients with STEMI of infarction related artery (IRA) TIMI≤Ⅰandthrombus for primary PCI were divided into two groups of conventional thrombusaspiration,42patients with intracoronary injections of tirofiban treatment as study group and42patients vein for tirofiban as control group,two groups both had successful stentsimplantation.TIMI flow after stents implantation,30days later left ventricular ejectionfraction(LVEF)and left ventricular end-diastolic diameter(LVEDD), single-STR (ST-segmentresolution)≥50%,major adverse cardiovascular events (MACE)during in hospital and30daysafter PCI,the complication of bleeding rare in hospital, before and after PCI changes of plasmavWF were all compared between the two groups.Results1.Compared with TIMIⅢof two groups after stents implantation, study group(n=40) was higher than control group (n=33),and difference was statistically significant(P<0.05);2.Compared with ECG single-the STR≥50%of two groups60min after PCI, studygroup (n=35) was higher than control group (n=24),and difference was statistically significant(P<0.05);3.Compared with left ventricular ejection fraction (LVEF)and left ventricularend-diastolic diameter (LVEDD)of two groups30days after PCI,LVEF of study group (52.8±4.2%) was higher than control group(48.6±3.9%),and LVEDD of study group (50.8±5.1mm) was lower than control group (54.6±3.8mm),and differences were statistically significant(P<0.05);4.Compared with MACE of two groups during in hospital and30days after PCI,study group(n=5) was lower than control group (n=11),and differences was statisticallysignificant (P<0.05);5.Compared with vWF of two groups after stents implantation, vWF ofstudy group (143.29±1.16μg/l)was lower than control group (151.72±0.98μg/l),and differencewas statistically significant (P<0.05).Among patients with STEMI TIMIⅢ (n=73) of vWF(159.62±0.70μg/l) was significantly lower than TIMI≤Ⅱ(n=11) of vWF (162.01±1.87μg/l)before PCI,no significant difference(P>0.05);6.Compaerd with control group,the complicationof bleeding rate in hospital showed higher in the study group (7.1%:9.5%),but there is nodifference statistically between two groups.Conclusion1. Intracoronary injection of tirofiban in patients with STEMI during PCIcould improve coronary arterial perfusion rate and decrease the occurrence of no-reflowphenomenon;2. Intracoronary injection of tirofiban in patients with STEMI during PCI couldimprove postoperation ST-segment reslution and myocardial tissue perfusion;3. Intracoronaryinjection of tirofiban in patients with STEMI during PCI could protection heart function anddecrease MACE rate;4. Intracoronary injection of tirofiban in patients with STEMI during PCIprotection of endothelial、could reduce of vWF level and improve of TIMI flow;5.Intracoronary injection of tirofiban in patients with STEMI during PCI is safe, effective, andno increase in bleeding events and adverse drug reactions.