Clinical Study Of Intracoronary Injections Of Tirofiban On No-reflow Phenomenon In Patients With Acute Myocardial Infarction During Percutaneous Coronary Intervention

Objective:To observe the clinical effect of intracoronary injections of tirofiban on no-reflow phenomenon in patients with acute myocardial infarction (AMI) during percutaneous coronary intervention(PCI).Methods:From January 2005 to September 2009,45 patients with acute myocardial infarction who had no-reflow phenomenon during PCI were enrolled for intracoronary injections of tirofiban treatment as study groups,49 patients with acute myocardial infarction during the same time who had no-reflow phenomenon during PCI were enrolled for intracoronary injections of verapamil treatment as control. Thrombolysis in myocardial infarction(TIMI) flow grade, corrected TIMI frame count (cTFC) and TIMI myocardial perfusion grade (TMPG) were assessed from the first contrastographic picture after drug administered and the last one at the end of PCI. Left ventricle ejection fraction (LVEF) during one week after PCI, major adverse cardiovascular events (MACE) in hospital and 60 days after PCI and the complication of bleeding rate in hospital were all compared between the two groups.Results:1 Compared with control group, the patients treated with tirofiban were significantly better TIMI3 flow degree in the first contrastographic picture after drug being administered (63.0% vs.40.8%,P<0.05) and in the last one of post-PCI (78.3% vs.49.0%, P<0.01).2 Compared with control group, the patients treated with tirofiban were significantly decresased cTFC in the first contrastographic picture after drug being administered (38.6±7.1 vs.49.3±9.3, P<0.01) and in the last one of post-PCI (28.5±6.4 vs.40.4±8.7, P<0.01).3 Compared with control group, the patients treated with tirofiban was found to have higher rate of TMPG 3 in the first contrastographic picture after drug being administered (54.3% vs.32.7%, P<0.05) and the last one of post-PCI (71.7% vs.46.9%, P<0.05).4 Compared with control group, the tirofiban group enhanced LVEF during one week after PCI (50.5±8.9% vs.44.2±6.8%, P<0.01).5 Compared with control group, the tirofiban group decreased MACE in hospital (33.1% vs 55.1%, P<0.05) and 60 days after PCI (39.1% vs.44.9%,P<0.01).6 Compared with control group, the complication of bleeding rate in hospital showed higher in the tirofiban group(21.7% vs.10.2%), but there was not statistical significant in between two groups (P>0.05).Conclusions:Intracoronary injections of tirofiban on no-reflow phenomenon in patients with acute myocardial infarction during PCI could improve acoronary arterial blood flow and myocardial tissue perfusion, decrease MACE in hospital and 60 days after PCI. It did not increase the complication of bleeding rate in hospital. It may be a simple and effective treatment way on no-reflow phenomenon in patients with acute myocardial infarction during percutaneous coronary intervention.