Glinicalstudy Of Early Application Of Tirofiban In Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

ObjectiveThrough the veins early application of tirofiban and percutaneous coronary intervention (PCI) application of platelet GPâ…¡b/â…¢a receptor antagonists were like two methods for acute coronary syndrome (ACS) patients PCI after myocardial injury, inflammatory factor, cardiac index level and cardioascular events compared adverse outcome etc;to compare the two methods of ACS patients PCI postoperative outcomes. Explore the ACS good use for PCI were at the right time, and way, and explore the mechanism except contradict platelet.So to provide more science use for tirofiban clinical treatm-ent.Methods1,108 patients with ACS received PCI treatment in our hospital were selected from Jan 2009 to Jan 2010.They were divided randomly into vein group and coronary artery group(n=54 in each group). Patients in vein group were treated with tirofiban 30 min before operation, in loading dose 10ug/kg by intravenous injection within three minutes, then last for 36 hours intravenous drip by 0.15ug/kg min maintenance dose.Patients in coronary artery group recei-ved tirofiban in loading dose 10ug/kg coronary artery, using projectile injection within three minutes before transplanting stent, then last for 36 hours intrave-nous drip by 0.15ug/kg min maintenance dose. To Compare the cardiac troponin I, myoglobin, creatine kinase isoenzyme, high-sensitivity C-reactive protein, N-terminal pro-B-type natriuretic peptide, matrix metalloproteinase-1, soluble vascular cell adhesion molecule-1, soluble intercellular adhesion molecule-1, sero soluble CD40 ligand and the change of incidence of the major cardiovasc-ular events (heart failure, myocardial infarction, target vessel revascularization and death) between two groups before and after therapy. Result1.The troponinâ… , myoglobin, creatine kinase isoenzyme, high-sensitivity C-reactive protein, N-terminal pro-B-type natriuretic peptide, matrix metalloproteinase-1, soluble vascular cell adhesion molecule-1, soluble interce-llular adhesion molecule-1, soluble CD40 ligand of both the vein group and the coronary artery group were declined(P<0.05).However, these factors of the vein group declined significantly compared to these of the control group (P<0.05) One month after treatment, LVEDD of both the vein group and the coronary group decreased gently (p<0.05),LVEF increased (P<0.05). but, LVEDD and LVEF of the vein group declined significantly compared to these of the coronary group (P<0.05)2. Compared with the coronary artery group, incidence of the major cardiovascular events (heart failure, myocardial infarction, target vessel revasc-ularization and death) of the vein group decreased significantly (p<0.001).Conclusion1. Compared with the coronary artery group (received tirofiban before transplanting stent),the troponinâ… , myoglobin, creatine kinase isoenzyme, high-sensitivity C-reactive protein, N-terminal pro-B-type natriuretic peptide, matrix metalloproteinase-1,soluble vascular cell adhesion molecule-1, soluble interce-llular adhesion molecule-1,soluble CD40 ligand of the vein group (received tirofiban 30 min before operation) decreased significantly in patients with acute coronary syndrome by emergency PCI. It is proved that tirofiban has multiple actions except contradict platelet effect, Including improving endothelial function, anti-inflammatory role, improving ventricular remodeling, stable coronary artery plaque, inhibiting thrombosis and so on.2. Compared with the coronary artery group (received tirofiban before transplanting stent), incidence of the major cardiovascular events of the vein group (received tirofiban 30 min before operation) was decreased significantly.