The Effect And Prognosis Of Tirofiban Combined With Thrombus Aspiration In Emergency PCI For STEMI

Background As China is facing the dual pressure of population aging and the continuous prevalence of metabolic risk factors,the burden of cardiovascular disease(CVD)continues to increase,and CVD has become one of the major diseases threatening the life and health of residents.ST segment elevation myocardial infarction(STEMI)is a kind of acute disease with high mortality rate in CVD,and its incidence rate has increased in recent years.With the maturity of direct percutaneous coronary interventions(PCI),the mortality and prognosis of STEMI patients have improved significantly.However,there are still some patients with STEMI who have no reflow phenomenon(NRP)after operation,which reduces the efficacy of PCI and affects the prognosis of patients.At present,relevant drugs and mechanical treatment can effectively reduce the incidence of NRP and improve the effect of reperfusion.Common treatment strategies include the use of thrombus aspiration combined with platelet membrane glycoprotein Ⅱ b/Ⅲ a inhibitors(GPI)during PCI.Tirofiban,as one of the representative drugs of GPI,is widely used in antithrombotic therapy.In theory,the combination of the two can further improve the efficacy of PCI.In fact,with the deepening of clinical trials,it is found that the routine use of thrombus aspiration in PCI does not improve the long-term clinical prognosis of patients,but increases the incidence of stroke events,and its safety and effectiveness are questioned.In the STEMI patient management guidelines issued by the European Heart Association in2017,the conventional thrombus aspiration was reduced from IIa to III(not recommended).However,thrombus aspiration is still active in clinical treatment of reducing thrombus load during PCI.The purpose of this study is to compare the therapeutic effect and prognosis of the two methods of intracoronary injection of tirofiban alone and combined use of thrombus aspiration for STEMI patients undergoing emergency PCI treatment,so as to explore the therapeutic value of combined use of thrombus aspiration on the basis of coronary injection of tirofiban.Methods We collected 171 STEMI patients from Fuyang People’s Hospital from January 2018 to April 2021 who went to the emergency department of cardiovascular medicine for PCI treatment after seeing a doctor in the emergency department.They were divided into study group(74 cases)and control group(97 cases)according to different treatment methods during operation.The study group used thrombus aspiration catheter combined with intracoronary injection of tirofiban during PCI,while the control group used intracoronary injection of tirofiban alone.The blood flow classification,CKMB peak,ejection fraction within 1 week after operation,incidence of adverse cardiovascular events,incidence of stroke,incidence of bleeding,length of stay,cost and rate of re-hospitalization within 1 year after operation were compared between the two groups,and the related influencing factors of total MACE events within 1 year after follow-up were analyzed.T-test,rank sum test χ 2 test or Fisher’s exact test,the factors with statistical significance in univariate analysis were included in multivariate logistic regression analysis.Results There was no statistically significant difference between the two groups in terms of TIMI blood flow grade,CKMB peak,ejection fraction,adverse cardiovascular events,incidence of stroke,incidence of hemorrhage,and readmission rate due to cardiovascular disease within 1 year after operation(P>0.05).However,compared with the control group,the study group had longer hospitalization days(Z=-2.459,P=0.014)and more hospitalization expenses(Z=-2.207,P=0.027).The difference was statistically significant.Killip grade II to IV(OR=12.390,95% CI=4.133,37.139)was an independent risk factor for postoperative MACE events(P<0.05).Conclusions 1.Compared with the use of tirofiban alone in emergency PCI for STEMI patients,the use of thrombus aspiration on the basis of intracoronary injection of tirofiban has no further improvement in clinical efficacy and the incidence of adverse events related to prognosis has been reduced.On the contrary,there is the possibility of prolonging the length of hospitalization and raising the cost of hospitalization,so it should not be recommended for routine use.2.The intracoronary injection of tirofiban and the use of thrombus aspiration are safe,and do not increase the risk of massive bleeding during and after PCI in STEMI patients.3.Killip grade II to IV may be an independent risk factor for MACE events in STEMI patients undergoing emergency PCI.