Evaluationon The Efficacy And Safety Of Upstream Versus Downstream Administration Of Tirofiban In The Treatment Of Acute Coronary Syndrom With Pci

Objective To compare the therapeutic effects and safety on patients with acute coronary syndrome(ACS) treated by percutaneous coronary intervention(PCI) between early use of tirofian and late use.The aim of the study also to assess whether there are age-dependent differences of the result.Methods 103 patients with ACS theated by PCI were studied by case control,all patient allocated to either early administration of tirofiban before taken PCI(The early group,n=55) or later administration of tirofiban after taken coronary agiograpy(The later group, n=48) . Tirofibna was administered intravenously with a lodaing dose of 10μg/kg for 3 minutes,followed by infusion of 0.15μg/(kg·min). Maintained for 36 to 48 hours. Patients received aspirin 300mg and clopidogerl 300mg if theated by emergency PCI, received aspirin 100mg/day and clopidogerl 75mg/day(≥3days) if theated by selective PCI.Clinical infofmation,platelet aggregation rate (PAR), coronary agiograpy (CAG) features,the incidence of major adverse cardiac events(MACE) and bleeding complications during the residential period after PCI , the incidence of MACE 30 days after PCI were compare between the two groups. On the basis of cut off age,patients were analysed separatedly.Results The clinical characteristics were comparable between the early and the later group. The TIMI grade 3 flow was significantly more fraquently observed in early group compared with that in later group(63.6%vs43.8%,P=0.043). PAR 24 hours after used tirofiban was lower than before used in both groups. (The early group 13.11±4.70vs46.69±10.74,P=0.000,The later group 14.56±5.54vs45.66±11.51,P=0.001). The incidence of MACE during the residential period and 30 days after PCI were similar compared between the tuo groups, the incidence of bleeding complications also similar.The incidence of MACE during the residential period after PCI increased in old patinentscompared with younger patients (20.5%vs5.1%, P =0.016), the incidence of bleeding complications and the incidence of MACE 30 days after PCI were similar.In old patients, the TIMI 3 grade flow in early group was more than the later group(51.7%vs33.3%), the incidence of MACE during the residential period and 30 days after PCI with a downward tendency(13.8%vs33.3%,7.4%vs21.4%).Conclusion 1.Tirofiban could effectively inhabit platelet aggregation. 2. Tirofiban is safety according to our study ,early application of tirofiban beofer PCI could dramatically increase the rate of TIMI3 grade flow. 3.Tirofiban is relatively safe for old patients, the monitor of bleeding should enhance.