The Applied Research Of The Tirofiban In ST-segment Elevation Myocardial Infarction In Emergency Interventional Treatment

Acute ST-segment elevation myocardial infarction (ST-elevation myocardial infarction, STEMI) is the clinical syndrome of making coronary artery acute occlusion based on coronary atherosclerosis, plaque rupture.When Acute ST-segment elevation myocardial infarction (STEMI), the coronary artery (coronary artery) atherosclerosis plaque rupture, activated platelets and coagulation process, resulting in complete obstruction of coronary thrombosis, blood flow interruption. Early, sustained, effective reperfusion therapy can significantly reduce the myocardial infarct size, save the left ventricular function, reduce mortality and improve the clinical prognosis of patients with STEMI. At present, direct percutaneous coronary intervention (PCI) has become the preferred treatment for STEMI. However, PCI can make the thrombo shed to result the distal microcirculation embolism, at the same time because exist the reperfusion injury, microvascular structural damage and microvascular coronary artery spasm and other factors. even if criminals vascular blood flow to achieve TIMI 3 level, myocardial reperfusion has not been true, or even a"no-reflow phenomenon".resulting in decreased clinical efficacy of emergency PCI. When the no-reflow occurs, how to lift the plug of capillary, the rapid recovery of myocardial tissue perfusion and restore Prior to the blood flow Already become a involved problems for a cardiovascular doctor .Traditional treatment methods, including coronary injection of nitroglycerin, verapamil and three cAMP and so on, have a certain effect, but the lack of large-scale clinical evidence to support . at this stage still has not the ideal of no-reflow means. Large study found that the key to the treatment of inhibiting the formation of microthrombus to be true myocardial reperfusion. Therefore, the anti-platelet therapy plays a crucial role.Effective anticoagulant, anti-platelet adjuvant therapy can significantly improve the microcirculation, and reduce the ischemic myocardial cell damage, thus further improving the acute STEMI after PCI in patients with left ventricular function and clinical prognosis. Clinical study found that positive anti-platelet therapy can significantly reduce myocardial infarction after emergency PCI in patients with adverse major adverse cardiovascular events (MACE) incidence. platelet membrane glycoprotein (GP) IIb / IIIa receptor antagonist acting on the terminal link of platelet aggregation can provide the most effective anti-platelet aggregation, reduce load and secondary thrombosis of microcirculation thrombosis, contribute to the restoration of the true level of myocardial tissue perfusion. Therefore 2004 ESC expert consensus has been included in acute myocardial infarction the use of direct stenting ofⅠA type indication. Tirofiban is a platelet membrane glycoprotein (GP) IIb / IIIa receptor antagonist, this study investigate its acute ST-segment elevation myocardial infarction in emergency PCI efficacy and safety impact.Objective: To assess coronary flow,the safety and myocardial perfusion of the national produced tirofiban in patients with ST-segment elevation myocardial infarction (STEMI) during primary percutaneous coronary intervention (PCI)Methods:Collection of Jilin University, China-Japan Friendship HospitalCardiology Department from March 2007 to December 2008 collection live in acute myocardial infarction patients with emergency coronary angiography prompted infarct-related artery blood flow TIMI 0～1 level parallelism percutaneous coronary intervention (PCI ) 128 cases of patients with clinical data. Preoperative accepted United tirofiban therapy in patients with income of 64 cases of treatment group, 64 cases of patients with other income of the control group, the collection of all cases of clinical and coronary angiography data, observation of PCI preoperative and postoperative TIMI flow situation. Preoperative and postoperative 90 minutes, 24 hours, 1 weeks of conventional 12-lead ECG. After about 7 day for echocardiography determination of left ventricular ejection fraction, basic clinical characteristics were compared between two groups, myocardial blush grade (MBG) and after 90 minutes, 24 hours, 1 weeks down the percentage of ECG-ST (sumSTR), and to observe the major cardiovascular events during hospitalization (death, new myocardial infarction and refractory ischemia state),and left ventricular rejection fraction, and adverse drug reactions (bleeding, thrombocytopenia ).All data analysis using statistical software SPSS13.0. Measurement data (in this study are in line with the normal distribution) with the mean addition and subtraction in mean difference. using t tests, count data usingχ2 test.Results:1. PCI preoperative coronary flow of 0～3 Comparison of incidence of the two groups was no significant difference; but Tirofiban team TIMI 3 flow level higher than that (20.3% vs 14.1%).PCI postoperative Tirofiban team with the control group TIMI 3 level flow rate (93.8% vs 81.3% P = 0.033), TIMI 0～2 level incidence rate (6.3% vs 18.8% P = 0.033 ). 2. Tirofiban team after 90minutes ECG ST-down rate of complete (sumSTR≥70%) was significantly higher than that (56.3% vs31.3% P = 0.004 ), Tirofiban PCI team after 24 hours and 1 week full-ST drop rate was significantly higher than that (73.4% vs 50.0% P = 0.006 and 81.3% vs 62.5% P = 0.018 ). 3. PCI postoperative Tirofiban team LVEF (%) was significantly higher than that (60.47±9.26 vs 52.73±12.48 P <0.01). 4.Tirofiban team happened without myocardial reperfusion situation was significantly lower than the control group (1.6% vs 10.9% P = 0.028 ), and reached MBG 3 grade more than the control group (84.4% vs 70.3% P = 0.057), Tirofiban team happened during reperfusion arrhythmia was significantly lower than the control group (9.4% vs 25.0% P = 0.019 ). 5. two groups of patients hospitalized during the 24-hours and 15-day incidence of MACE, Tirofiban team lower than the control group (6.3% vs 17.2% P = 0.054 and 18.8% vs 31.3% P = 0.102), two groups happen no substantial bleeding and cerebral hemorrhage phenomenon, not caused by decreased hemoglobin, two groups of patients for the incidence of bleeding (21.9% vs 14.1% P = 0.250) Tirofiban team bleeding adverse reactions is higher than the control group. Tirofiban team events of 14 cases of hemorrhage, of which three cases of gingival bleeding, then two cases of occult blood, nine cases of urine occult blood, no special treatment; control group, 9 cases of bleeding events, of which two cases of bleeding gums, then one cases of occult blood, six cases of urine occult blood, the incidence of hematoma puncture points, Tirofiban team higher than the control team (6.3% vs 3.1% P = 0.403) but no statistical significance, the extended time of oppression improved compression bandaging. Postoperative incidence of no-reflow, Tirofiban team was significantly lower than the control group (6.3% vs 18.8% P = 0.033 ). 6. two groups of patients with APTT monitoring extension, are controlled at the basic level of 1.5～2.0 times. Tirofiban team after the extension of APTT than control group (57.40±7.32 vs 45.24±8.37 P <0.01); oppression hemostasis time was significantly longer (37.69±5.68 vs 25.61±5.05 P <0.01). But to no increase in bleeding and hematoma puncture point. Two groups of patients after treatment than before platelet decreased, but still within normal range without clinical significance. The two groups did not happen thrombocytopenia.Conclusion:1. Acute myocardial infarction patients with direct PCI when the application of domestic United tirofiban can improve coronary blood flow and regional myocardial infarction, STEMI patients can be improved infarct-related artery (IRA) of TIMI flow And MBG grade. To save the frequency of cardiac death. Reduced after infarction.2.Tirofiban hydrochloride can improve acute ST-segment elevation myocardial infarction patients with left ventricular function, and reduces the hospitalization period the incidence of cardiovascular events.3. PCI intraoperative incidence of reperfusion arrhythmias is lower .4.Hydrochloric acid tirofiban direct PCI can reduce the no-reflow occurrence with STEMI after reperfusion .5. Tirofiban hydrochloride although the increase in the incidence of bleeding in patients with mild increase, but it does not increase the incidence of severe bleeding complications. two groups of patients with no severe bleeding complications, confirmed that tirofiban in direct PCI in AMI has good security.