| Objective:In this randomized study, we performed the comparison of tirofiban using and not using before percutanous coronary intervention (PCI) in the acute myocardial infarction (AMI) patients by the coronary angiography (CAG) and equilibrium radionuclide angiography (ERNA) on the effects and complications. We evaluated the effect and safety of tirofiban during emergency PCI in AMI, in order to provide a more rational strategy of perfusion treatment for AMI patients.Methods:From January 2005 to December 2006, 104 patients( 97 male and 7 female, average age was 52.90±10.35 years old ) who had myocardial infarction within 12 hours were enrolled in our study. All patients had persistent angina for more than 30 minutes and the cardiac enzyme peak beyond two folds of normal range and troponin positive and / or ECG showed ST segment elevation beyond 2 leads or new left bandle branch block. Patients with bleeding diathesis, thrombocytopenia, administration of thrombolytic agents for the current episode, recent stroke, and known contraindications of anticoagulation therapy were all excluded. These 104 cases randomized to divide into two groups which were the tirofiban group ( n=48, 45 males, 3 females, mean years was 53.86±11.14 ) and the control group( n=56, 52 males, 4 females, mean years was 51.95±9.56 ). We gave tirofiban (10μg/kg over 3 minutes as a bolus, followed by 0.15μg/kg/ min administration ) before CAG in the tirofiban group. Then the patients were transfered to the catherlab at once and received the CAG. If the stenosis of IRA was beyond 70%, we perform the PCI. In the control group, the patients only received CAG and PCI. Before the CAG, we used enough clopidogrel, aspirin and heparin in both groups. ACT was controlled about 250 seconds. During the PCI, we only treated the IRA. In each group, we collected clinical information detailed including: age, gender, risk factors, angina before AMI, location of AMI, distribution of lesions, heart function, the mean interval from onset to PCI and the hemorrhage events and MACE in hospital. We used QCA ( the narrow more than 70 percent was positive ) and TMP to analysis the lesion and reperfusion of the IRA and myocardial. We recorded the platelet aggregation rate of the two groups. All patients received ERNA in 1 week from the PCI to evaluate the heart function. We used SAS 6.12 statistics software to analysis all of the data. The variables were presented as the means and the SD. Differences between group means were assessed with the t test. TheΧ2 analysis or the Fisher exact test was used to test differences between proportions. Statistical significance was indicated by P value <0.05.Result:There was no significant differences about age, gender, risk factors, pre-angina, the location of the AMI, heart function, and the mean interval from onset to the PCI between the two groups. A greater percentage of TIMI 1 flow of IRA was achieved in the tirofiban group compared with the control group before PCI (41.67% vs 21.42%, P<0.05). The percentage of TIMI 3 flow of IRA after the guild wire first crossing was higher (37.50% vs 17.86%, P<0.05) in tirofiban group. The percentage of TIMI 3 flow of tirofiban group after PCI was higher than the control group(93.75% vs 80.36 %, P<0.05). The CTFC was fewer in the tirofiban group (21.84±8.95 vs 30.29±3.42, P<0.05) after PCI. Slow-reflow was fewer in the tirofiban group ( 6.25% vs 19.64%, P<0.05 ). The myocardial perfusion was better in the tirofiban group. The percentage of TMP beyond 2 grade was higher in the tirofiban group (75.00% vs 53.57%, P<0.05). The left ventricular ejection fraction (LVEF), left ventricular peak ejection rate (LPER), the left peak filling rate (LPFR) 1 week after PCI in the tirofiban group is higher than the control group (57.87±7.11% vs 51.55±5.91%, 2.87±0.42 vs 2.32±0.36 and 2.41±0.38 vs 2.05±0.31, p<0.01, respectively), and the left ventricular time to peak ejection rate (LTPER), left ventricular time to peak filling rate (LTPFR) were lower in the tirofiban group (152.88±21.45 vs 192.14±28.98, 158.93±31.76 vs 201.65±27.31, p<0.01, respectively). The platelet aggregation rate in the tirofiban group was lower after tirofiban administration for 0.25, 0.5, 2, 6 and 12 hours. There was no significant difference in hemorrhage events between two groups. There was a lower MACE in the tirofiban group compared with the control group during the hospital (6.25% vs 16.64%, P<0.05).Conclusion: There are a number of potential benefits of tirofiban which used before the emergency PCI for AMI. These include (1) tirofiban can quickly inhibit the platelet aggregation, so very suitable for the emergency PCI (2) tirofiban make more IRA patent before PCI, so make PCI easy and safety (3) tirofiban can increase coronary blood flow, improve tissue-level perfusion and preserve the heart function (4) tirofiban can decrease the MACE, but not increase the hemorrhage events.
|
PDF Full Text Request