The Effects Of Tirofiban And Different Administration Of Tirofiban On Level Of SICAM-1in Acute Myocardial Infarction Patients After Percutaneous Coronay Intervention

BackgroundWith the improvement of contemporary living standards, accelerated pace oflife, change in diet, the increasing proportion of the elderly population, people withcoronary heart disease (CHD) are more and more people and tend to be younger.Acute myocardial infarction (AMI) is the most serious clinical type. AMI, whichbecomes one of the killers to human health, reduces the survival rate and quality ofhuman life. Currently, Percutaneous coronary intervention (PCI) is simple, relativelysafe, less pain, and can quickly make coronary revascularization, etc., so it hasbecomes a routine method for AMI treatment. Although PCI treatment has beenrelatively mature, the in-stent restenosis(ISR) after PCI affect the prognosis ofpatients with AMI, and plague the majority of clinicians.Many clinical studies show that the formation of ISR after PCI is related toendothelial damage, inflammation, renin-angiotensin system overactivation, geneticfactors, surgical factors, particularly inflammation which deteriorate ISR after PCI.A recent double-blind, large-scale, multi-center and randomized controlled trialshowed that soluble intercellular adhesion molecule-1(sICAM-1) is involved in the inflammatory response and adhesion reaction in ISR after PCI. It not only strengthenthe adhesion of platelets and inflammatory cells, but it aslo is involved in thevascular endothelial injury, cause vasoconstriction, lead to further myocardialischemia and hypoxia, make AMI deterioration. Platelet glycoprotein (GP)IIb/IIIareceptor antagonist-tirofiban, on the one hand, prevent the binding of fibrinogenand GP IIb/IIIa receptor, blocking platelet aggregation; On the other hand, it inhibitadhesion molecules, chemokines, and the expression of inflammatory cytokines toreduce the inflammation. Thereby, it serves to reduce the incidence of adversecardiovascular events after PCI, and improves prognosis.This study observed patients with AMI who undergo PCI treatment, and theplasma levels of sICAM-1before PCI and24hours after PCI were measured. Itfurther confirms that tirofiban can reduce the rate of ISR after PCI and improveprognosis by inhibiting inflammation and reducing postoperative adhesion reaction.Thereby, it provides a richer basis for tirofiban to use in patients with AMI whoundergo interventional therapy.ObjectiveTo explore the effects of tirofiban and different administration of tirofiban onlevel of sICAM-1in acute myocardial infarction patients after percutaneouscoronary intervention.Methods90patients with AMI undergoing PCI were randomly divided into group A,group B and group C. Group A didn’t receive tirofiban neither via intracoronary (IC)nor intravenous(IV) route. Group B after PCI received tirofiban via IV route, GroupC during PCI received tirofiban via IC route and both of them were followed by a36hours of IV infusion. The plasma levels of sVCAM-1before PCI and24hours afterPCI were measured. Results1． A, B, C three groups of patients in the basic information, such as age, sex,smoking history, alcohol consumption, hypertension, diabetes mellitus, familyhistory of myocardial infarction, were not statistically different (P>0.05).2． A, B, C three groups were not statistically different (P>0.05) in the results ofthe basic biochemistry, such as blood glucose, blood lipids, liver and kidneyfunction.3． The level of sICAM-1in group A was higher than preoperative level, but groupB and C were opposite. The difference of the three groups were statisticallysignificant (P <0.05).4． There were no significant difference of the three groups in the level of sICAM-1before PCI (P>0.05).5． The postoperative plasma levels of sVCAM-1of Group A increased comparedwith the preoperative levels and the difference was statistically significant (P＜0.05), which was just opposite with Group B and Group C. There were nosignificant differences between Group B and Group C(P＞0.05).ConclusionThe level of sICAM-1was significantly increased in the AMI patients.Tirofiban can reduce the level of sICAM-1who received PCI timely and effectively.It can decrease the inflammatory response after PCI to reduce the rate of ISR. Itimproves the quality of life of AMI patients. The effect is independent with the routeof administration of tirofiban.