The Observation Of The Effect Of Different Route Of Medicine Administration To Prevent No-reflow For The Patients Suffered With Acute Myocardial Infarction

The preventive effect of Tirofiban and Nitroprusside to the patients with ST-elevation myocardial infarction ObjectivesTo compare the preventive effect of intracoronary injection of Tirofiban and Nitroprusside and intracoronary injection of normal saline to the patients with STelevation myocardial infarction. MethodsTotal of 196 patients with STEMI who received emergency PCI within 12 h of symptom onset from March 2011 to February 2013 were enrolled. Patients were randomly divided into two groups according to the medicine injected into coronary artery. Tirofiban and nitroprusside were injected to the patients in group A( n=98) through coronary artery, while normal saline were injected to the patients in group B( n=98) through coronary artery. The clinical characteristics, laboratory results,cardiac ultrasound,angiographic findings and intervention results between the two groups were compared. All the patients were followed up for half a year, and the cardiac function, major adverse cardiac events(MACE) of the patients in the two groups, including angina, target vessel revascularization, recurrent nonfatal myocardial infarction and cardiac deaths were observed. ResultsThe rate of no-reflow was significant lower in tirofiban and nitroprusside group than in normal saline group. Reperfusion arrhythmias including sinus tachycardia, sinus arrhythmia, frequent atrial premature beat, brief proxysmal atrial tachycardia, atrial fibrillation, and frequent premature ventricular beat or brief proxysmal ventricular tachycardia were less in the tirofiban and nitroprusside treated through coronary guidance catheter group than normal saline treated through coronary guidance catheter group. There no significant difference in the arrhythmia such as ventricular flutter or ventricular fibrillation, sinus bradycardia, second or first degree atrioventricular block and high degree atrioventricular block in the two groups. The peak of CK and CK- MB, and ST segment resolution index were obvious better in the tirofiban and nitroprusside treated through coronary guidance catheter group than the normal saline treated through coronary guidance catheter group. The LVEF, LVESV and LVEDV within 5-7 days post PCI and 1 month post PCI in the tirofiban and nitroprusside treated through coronary guidance catheter group is superior to the normal saline treated through coronary guidance catheter group. But the LVEF, LVESV and LVEDV on the sixth month post PCI were no evident difference in two groups of patients. Major cardiovascular adverse events, including death, target vascular remodeling, myocardial re-infarction, recurrence of angina and the complications such as bleeding was less in the tirofiban and nitroprusside treated through coronary guidance catheter group than the normal saline treated through coronary guidance catheter group. Conclusion:There was more advantage in acute ST elevated myocardial infarction treated with tirofiban and nitroprusside through coronary guidance catheter than treated with normal saline through coronary guidance catheter.The observation of the effect of different route of medicine administration to prevent no-reflow for the patients suffered with acute myocardial infarctionObjectiveThe patients suffered with acute ST elevated myocardial infarction(STEMI) treated with percutaneous coronary intervention(PCI) were selected to observe the prevention of no reflow or slow reflow. The effect was observed in the patients suffered with acute ST elevated myocardial infarction(STEMI) treated with coronary aspiration and medicine administrated by aspiration catheter route or by coronary guidance catheter route. The prognostic evaluation of the two different route of medicine administration was compared to evaluate the advantage and disadvantage.MethodTotal 80 patients suffered acute ST elevated myocardial infarction treated with percutaneous coronary intervention(PCI) during May 2012 to January 2014 were enrolled and randomized dividing into two groups. Total 40 patients with STEMI medicine administrated by coronary guidance catheter route as group A;40 patients with STEMI medicine administrated by coronary aspiration catheter route as group B. The general conditions such as age,gender,systolic blood pressure and diastolic blood pressure are examined.The coronary artery blood flow and cardiac function were examined. The major adverse cardiac event(MACE)such as acute or subacute stent thrombosis, myocardial reinfarction, target vessel revascularization and death were observed at one month and six months post PCI.ResultsThe general data such as sex, age, diabetes, high blood lipids, hypertension history, smoking history, admission blood pressure( including systolic pressure and diastolic pressure), heart rate, Killip cardiac functional grading, admission creatine, total cholesterol, glycerin ester, three low density lipoprotein cholesterol, high density lipoprotein cholesterol, troponin, creatine kinase isoenzyme, the ratio of neutrophils and cardiac ultrasound ejection fraction were not statistically different in coronary aspiration catheter route group and in coronary guidance catheter route group. There were no difference in the time from onset to admission to hospital, the time from arrival to emergency room to the dilatation of balloon to open occluded vessels, the index of thrombosis, the distribution of the infarct related vessel, the lesions involved vessels, collateral circulation and incidence of preoperative TIMI blood flow in two groups. There were no difference in stent length, stent diameter, and post expansion dilation in two groups. There were more patients reached to TIMI3 blood flow in coronary aspiration catheter route group than in coronary guidance catheter route group. There were more patients reached to TMP3 blood flow in coronary aspiration catheter route group than in coronary guidance catheter route group.One hour after PCI, there were more patients with the change of ST segment elevation regression >50% in ECG in coronary aspiration catheter route group than in coronary guidance catheter route group. There were no significant difference between the two group in the heart function(ejection fraction), target vessel revascularization, recurrent myocardial infarction, death and non-fatal cerebrovascular events during the admission period. There was less symptoms like angina and malignant arrhythmia in coronary aspiration catheter route group than in coronary guidance catheter route group. During the 1 month follow-up, there was better improvement in cardiac function in coronary aspiration catheter route group than in coronary guidance catheter route group. There was less symptoms like angina and malignant arrhythmia in coronary aspiration catheter route group than in coronary guidance catheter route group during the 1 month follow-up. There were no significant difference between the two groups in target vessel revascularization, recurrent myocardial infarction, death and non-fatal cerebrovascular events during the 1 month follow-up. During the 6th month follow-up, there was better improvement in cardiac function in coronary aspiration catheter route group than in coronary guidance catheter route group. There was less symptoms like angina and malignant arrhythmia in coronary aspiration catheter route group than in coronary guidance catheter route group during the 6th month follow-up. There were no significant difference between the two group in target vessel revascularization, recurrent myocardial infarction, death and non-fatal cerebrovascular events during the 6th month follow-up.Conclusion:The medicine administrated by coronary aspiration catheter route in the treatment of STEMI was better than the medicine administrated by coronary guidance catheter route.