Effects Of Tirofiban On Coronary Flow And Endothelial Cell Function In Patients With Acute Myocardial Infarction Treated By Primary Percutaneous Cronary Intervention

BackgroundThe main reason to result in acute myocardial infarction is the acute thrombosis in the coronary artery.Emergency percutaneous intervention is the main treatment to acute myocardial infarction.But in the process,the massive thrombus in the coronary artery is difficult to handle.The caducous thrombus and minute thrombosis in the surgery will induce distal vessel obstruction,meanwhile oxidative stress, inflammatory response and surgery mechanical injury will aggravate microcirculation disturbance.The no-reflow phenomenon often weaken the efficancy,thereby Infuence the PCI's curative effect and prognosis.Lately,some foreign clinical studies indicate that early use ofⅡb/Ⅲa receptor antagon may improve infarct-related artery flow,increase the effects of PCI,improve the patient's prognosis.But few studies on the STEMI patients treated by percutaneous coronary intervention have been reported. Tirofiban is a non-peptide plateletⅡ/Ⅲa receptor antagonist,it has high specifity advantage.Tirofiban take the occupancy of cross site through RGD (arginine-glycine-aspartic acid)succession,thereby competively inhibit platelet aggregation,which is mediated by blood coagulation factorⅠor von willebrand factor, and inhibite acute thrombosis,our study is to analyse the effect of tirofiban on STEMI patients treated by emergency percutaneous coronary intervention.Obejective1.To investigate the effect of Tirofiban on coronary flow,endothelial function and clinical prognosis in the near future in patients with STEMI treated by primary percutaneous coronary intervention.2.To explore the more reason which induce myocardial microcirculation disorder.3.To explore the more action mechanism of tirofiban.Material and methods1.Groups Divide the patients who were diagnosed as STEMI disease accepted the PCI and transplanted the stents between September,2006 and March,2007 in emergency center of our hospital,the provincial hospital affiliated to Shandong university,is randomely divided into Tirofiban treatment and control group.2.Medication Apply Tirofiban before transplanting stents in treatment group in emergency room,loading dose is 10ug/kg,intravenous injection within three minutes, the dose is decreased to half to the age＞70 or renal inadequacy patients,then last for 36 hours intravenous drip by 0.15ug/kg/min maintenance dose.After surgery,all the patients were sent into care unit.3.Sample collect All the patients were drawed blood from vena coronaria sinus through cardiac catheter technology before PCI is finished,15 millilitre blood were put into heprin-anticoagulation tube,remove blood plasma by centrifuge technology,then added into Ficoll-Hypaque cell demixing fluid to centrifuge mononuclearcell, detected apoptosis endothelial cell in PBS buffer fluid.In addition,take 5.4 millitre bood into 0.6 millitre(blood:decoagulant 9:1),then centrifuge to get blood plasma,detect vWF and TF content,take 1 millitre to decect PT and APTT,1 millitre is reserved at low temperature.To take peripheral vein blood(in the beginning of surgery,36h after surgery,72h after surgery)to decet sICAM-1 and sVCAM-1.4.detect indicatrix Endothelial cell apoptosis number,cogulation factor (TF,vWF),cell adhesion molecular(sICAM-1,sVCAM-1)PT,APTT. Use flow cytometry to decect Endothelial cell apoptosis number,detect TF,vWF and sICAM-1,sVCAM-1 by ELISA,detect PT,APTT on the radiometer(ACL-200).5.Observation indicatrix thrombolysis in myocardial infarction grade, Myocardial TIMI grading,corrected TIMI frame count,st-segment degression,90min after recanalization,clinical Observation indicatrix,major adverse cardic events in hospital(Non-fatal myocardial re-infarction,restruct criminal vessel cardiac death belleding situation(brain bleeding,gingival bleeding).Bleeding(major bleeding, minor bleeding)and thrombocytopenia.Following 30 days after surgery,comprehend the situation(myocardial re-infarction,heart failure,cardiac death).6.Statistics analysis All of the analyses was completed by statistical software package type SPSS 11.5 Statistical result with P＜0.05 had significant difference.Results1.A greater percentage of TIMI 1 flow was achieved in the tirofiban treatment+ PCI group(P＜0.05).On the other hand,TIMI 0 flow was more commonly found in patients in the control group(P＜0.01).There was no difference between the two groups in percentage of TIMI 3 flow achieved in IRAs after PCI(P＞0.05),but the occurrence of TIMI 2 flow was less in the control group.The no-refiow phenomean,reperfusion arrhythmia are more less in the experimental group(P＜0.05).2.faster ST segment resolution and high incidents of blush 3 grade in the tirofiban group after PCI.The corrected TIMI frame count in the experimental group is less than that in the control group(P＜0.05).3.Compared with the control group,The concentration of the endothelial cell apoptosis,blood coagulation factor,and celluar adhesion molecular were lower in the experimental group(P＜0.05).4.The incidences of refractory angina pectoris in hospital is less in the experimental group,The incidences of re-infarction and heat failure in the hospital as well as after30 days were much less in the experimental group compared with the control group(P＜0.05),the rate of bleeding and thrombocytopenia in both groups has no significant difference(P＞0.05).Conclusions and meanings 1.Tirofiban treatment can improve the rates of coronary TIMI flow to the AMI with PCI,the surgery can be done better.It can avoid more myocardial cell to die permanently.2.Application of Tirofiban in AMI patients treated by PCI is sfe and can improve microcirculation disfunction,and thereby enhance the patient's clinical outcome in the near future.3.Tirofiban could decrease the level of cogulation factor(vWF,TF)and cell adhesion molecular(sICAM-1,sVCAM-1),decrase the number of endothelial cell apoptosis,protect coronary artery endothelial function in the patients with STEMI treated by PCI,and thereby improve the patient's clinical outcome in the near future.