| Objective:This study was designed by recording the TIMI coronary flow grade ,TMPG myocardial blush perfusion ,CTFC during primary percutaneous coronary intervention in patients with acute ST segment elevation myocardial infarction , assaying the peak value and mean value of CK-MB and CTNI during 48 hours after pPCI, investigating the incidence of MACE, haemo- rrhage complication and thrombocytopenia during the hospitalization, to explore the clinical effects and safety of early application of tirofiban in patients with acute STEMI on different culprit vessel treated by primary percutaneous coronary interventionMethods : From September 2008 to march 2011 , 157 patients (132 male and 25 female , average age was 54.50±11.64 years old) who had been diagnosed as acute STEMI and preparing for pPCI were enrolled into this study .These patients were randomly divided into two groups : early group ,patients received tirofiban through vein in emergency room ; late group, patients received tirofiban through vein immediately before PCI in catheterization laboratory .The patients in each group were divided into different subgroups after diagnosed coronal artery angiography on the basis of characteristic of infarction related artery (IRA):LAD early group, LCX early group, RCA early group ; LAD late group, LCX late group, RCA late group. Patients who had same IRA were divided into one comparison group, and there were three comparison group : LAD comparison group, LCX comparison group and RCA comparison group. In each comparison group , we comparing the clinical information ,the result of PCI , CKMB and CTNI level during 48 hours after PCI and the incidence of majorcardiovascular adverse events (MACE), haemorrhage complication and thrombocytopenia during the hospitalization between two subgroups. At the beginning of the PCI, we recorded the TIMI coronary flow grade of culprit vessel ; we calculated CTFC after dilation with balloon, and investigated the TMPG myocardial blush perfusion grade after stenting . we draw venous blood before operation ,and 6,12,18,24,36,48 hour after PCI and assessed the level of CK-MB and CTNI , calculated the peak and mean value of them during 48 hours .Then we investigated the incidence of MACE,haemorrhage complication and thrombocytopenia during the hospitalization. At the last ,we used SPSS13.0 statistics software to analyze all date ,statistical significance was indicated by P<0.05.Result:1 LCX early group (n=5)and LCX late group (n=8) was excluded from this study due to their sample size was too small to analyze by statistics software. Actually , there were 144 patients was enrolled into our study (121 male and 23 female ,average age was 54.54±12.03 years old ) and there were divided into two comparison group: LAD comparison group and RCA comparison group.2 Comparison of basic clinical information .In LAD comparison group and RCA comparison group, there were no significant difference between two subgroups as regards the age , gender , weight , atherosclerotic risk factors and the time of angina to balloon .3 Comparison of result of PCI3.1 At the beginning of the PCIIn LAD comparison group , there were no significant difference in percentage of TIMI3 flow of IRA before PCI between early group and late group(35%vs17% P =0.072). In RCA comparison group , TIMI 3 flow was significant less frequent with late tirofiban compared with early application of tirofiban (34%vs14% P =0.044).3.2 After dilation with balloonIn LAD comparison group ,CTFC was significant lower with early tirofiban compared with late application of tirofiban (30.35±7.52vs36.22±11.78 P =0.014).In the RCA comparison group, early application of tirofiban was associated with lower CTFC in culprit vessel compared with late application of tirofiban (30.00±6.32 vs36.36±8.83 P =0.001).3.3 After stenting procedureIn LAD comparison group , there were no significant difference in the percentage of TMPG2/3 perfusion between early and late group(76%vs61% P =0.180); In the RCA comparison group , TMPG2/3 perfusion was significant less frequent with late tirofiban compared with early tirofiban group (74%vs47% P =0.020).3.4 In LAD and RCA comparison group, the percentage of thrombus duringPCI was significantly less frequent with early tirofiban compared with late tirofiban between every two subgroups (27%vs50% P =0.044)(49%vs81% P =0.005).3.5 In LAD comparison group, there were no significant difference in the percentage of no-flow and slow-flow between early and late group during the PCI(5%vs14% P =0.203).In RCA comparison group, percentage of no-flow and slow-flow was significant lower in early group than in late group(6%vs22% P =0.047).4 Comparison of the level of myocardial injury makers.4.1 In LAD comparison group, there were no significant difference in basic level of CK-MB and CTNI (94.41±25.97vs 101.21±23.83 P =0.248) (8.76±5.59vs8.99±5.06 P =0.860) between early application of tirofiban and late application before PCI. There were no significant difference in mean value of CK-MB during 48 hours after PCI between early application of tirofiban and late application (125.95±32.62vs142.94±41.72 P =0.055). There were also no significant difference in peak value of CK-MB during 48 hours after PCI (234.98±60.55vs249.84±55.79 P =0.280). The mean value of CTNI during 48 hours after PCI was significantly lower in the early group than in the late group(10.01±4.32vs11.95±3.29 P =0.035). The peak value of CTNI was significantly lower in the early group than in the late group(15.07± 5.28vs17.32±4.17 P =0.048).4.2 In RCA comparison group ,there were no significant difference in basic level of CK-MB and CTNI (86.82±23.79vs 87.30±24.65 P =0.934) (8.32±3.08vs8.03±3.73 P =0.717) between early and late group. There were no significant difference in mean value of CK-MB during 48 hours after PCI between early application of tirofiban and late application (93.22±26.24vs109.77±42.34 P =0.052).The peak value of CK-MB was lower in early application of tirofiban group than in late application group, the difference was significant (158.74±39.73vs190.87±72.23 P =0.022).,and the mean value and peak value of CTNI was significantly lower in early group than in late group(8.20±3.11vs10.63±3.90 P =0.005) (12.86±3.95vs15.92±5.61 P =0.010).5 Comparison of the incidence of MACE during the hospitalization. The cardiovascular events such as cardiac death, reinfarction , revascula- rization of IRA and serious angina were not happened in both LAD and RCA comparison groups during the hospitalization .6 Comparison of the incidence of the incidence of hemorrhage complication and thrombocytopenia during the hospitalization. In LAD and RCA comparison group, there were no significant difference in the percentage of hemorrhage complication (8.1%vs8.3% P=0.650) (8.6%vs5.6% P =0.486) between early group and late group. And there were no thrombocytopenia happened in both LAD and RCA comparison groups.Conclusion:1 Early application of tirofiban in the emergency room could improve the effect of primary PCI partly in patients with SEEMI which IRA was LAD. However, when culprit vessel was RCA , early application of tirofiban could improve the effect of primary PCI prominently compared with late application of tirofiban in catheterization laboratory ,such as better epicardial blood flow and myocardial tissue perfusion level .2 Regardless of the culprit vessel in acute STEMI was LAD or RCA, early application of tirofiban could effectively limit the expansion of infarction area. 3 Early application of tirofiban was not increase the incidence of MACE, hemorrhage complication and thrombocytopenia during the hospitalization.
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