The Efficiency Of Thrombus Aspiration Plus Intra-coronary Tirofiban During STEMI Primary PCI About No-reflow And Slow-reflow

Objective:To investigate whether thrombus aspiration plus intra-infarct-related arterybolus administration of tirofiban via the aspiration catheter is playing a role in inreducing no-reflow and slow-reflow of patients with ST-elevation myocardial infarction(STEMI)whose TIMI flow was 0 grade undergoing direct emergency percutaneous coronary intervention(PCI)therapy.Methods:In this single center retrospective study,we analysis the STEMI patients of our hospital who accepted primary PCI total of 107,divided into two groups.The PTCA group: 58 patients with STEMI who underwent PTCA or PCI alone,and the other group-thrombus aspiration+ tirofiban group(combined treatment group): 49 matched control patients with STEMl who underwent PTCA or PCI after thrombus aspiration plus intra-infarction related artery 500 ug tirofiban administration through bolus injection,and intravenous infusion tirofiban of 0.1μg·kg-1·min-1 continuous 12-36 hours.The primary end points included thrombolysis in myocardial infarction(TIMI)flow immediately after angioplasty,complete ST-segment resolution rate at 90 minutes after angioplasty and the peak of creatine kinase-MB(CK-MB)and troponin I(Tn I)in 12 hours.Secondary end points were in the hospital and at 12 months follow-up with major adverse cardiac events(MACE:re-infarction,cardiac death,cardiac shock,NYHA IV),mortality rate,bleeding events and stroking rate in 30 days after PCI.Results:Baseline characteristics of the two groups were well-balanced.The TIMl 3 flow rate before PCI(87.5% vs.53.4%,P<0.001),after PCI(93.9% vs.79.3%,P=0.017),no-reflow and slow-reflow rate(6.1% vs.20.7%,P=0.017).The complete ST-segment resolution rate(73.5%VS.53.4%,P=0.026)were significantly lower in the combined treatment group than in the PTCA group.The peak of CK-MB(174u/L vs.224u/L,P=0.034)and Tn I(39.6ug/L vs.66 ug/L,P=0.018)were significantly lower in the combined treatment group than in the PTCA group.There was a tendency to decreased MACE rate at 12 month follow up,which favored the combined treatment group(log rank χ2=0.664,P=0.415).Bleeding and stroking events were similar between the two groups.Conclusion : Thrombus aspiration plus intra-infarct-related artery bolus administration of tirofiban in patients with STEMI whose target vessel TIMI 0 flow undergoing direct emergency PCI may improve myocardium perfusion and reduce no-reflow and slow-reflow compared to direct PTCA alone.Trombus aspiration plus intra-infarct-related artery bolus administration of tirofiban didn’t increase MACE events or stroking events,but improved the efficiency of target artery recanalization.And it may reduce mortality during perioperative period.