The Application Of Aspiration Thrombectomy And Tirofiban In Primary Percutaneous Coronary Intervention

Objective Comparison of thrombus aspiration (thrombus aspiration) and platelet glycoprotein (glycoprotein, GP)Ⅱb /Ⅲa receptor antagonist - tirofiban in patients with acute ST-segment elevation myocardial infarction (STEMI) with primary percutaneous coronary intervention (PPCI) for different applications by postoperative myocardial perfusion, cardiac markers, cardiac structure and function, and prognosis.Methods Consecutive selected a total of 114 cases with STEMI in our hospital from November 2009 to April 2010,witch is divided into three groups according to the different methods treated thrombosis during the course of PPCI :the simple intervention groups (control group) (n = 35), thrombus aspiration group (n = 42), thrombus aspiration + tirofiban (n = 37). After the operation each group was compared thrombolysis in myocardial infarction (TIMI) flow grade, TIMI myocardial perfusion (TMP) grade, corrected TIMI frame count (CTFC), 50% ST segment drop after 2 hours, Creatine kinase isoenzyme(CK-MB), troponin I (cTnI) and high sensitivity C-reactive protein (hs-CRP) peak and the peak time, serious bleeding, recurrence of myocardial infarction and death during hospitalization. After 1 week and 6 months, left ventricular ejection fraction (LVEF), wall motion score (WMS), left ventricular end-diastolic volume (LVEDV), left ventricular end systolic volume (LVESV) ,are detected by cardiac ultrasound, respectively, according to test results wall motion score index (WMSI), end-diastolic volume index (LVEDVI) and systolic volume index (LVESVI) calculated, and cardiac function recovery of the three groups will be compared. Finally, major adverse cardiovascular events (MACE), including cardiac death, myocardial re-infarction, stroke, and the incidence of target vessel revascularization of the three groups at 1 month and 6 months will be compared.Results 1. Compared with the control group, thrombus aspiration group and the thrombus aspiration + tirofiban group blood perfusion of TIMI 3 level immediately postoperative was significantly increased(83.33% vs 59.46%,P<0.05;86.49% vs 59.46%,P<0.05), the proportion of patients with no-reflow (TIMI≤2level) significantly reduced(16.67% vs37.14%,P<0.05;13.51% vs 37.14%,P<0.05). Compared with the control group, CTFC count in thrombus aspiration group and the thrombus aspiration + tirofiban group significantly reduced(21.8±7.2 vs 31.5±5.8,P<0.05;20.9±6.3 vs 31.5±5.8,P<0.05); the proportion of patients with myocardial perfusion grade TMP3 also significantly increased in the thrombus aspiration group and the thrombus aspiration + tirofiban group(80.95% vs 60%,P<0.05;83.78% vs 60%,P<0.05), while the proportion of patients with TMP0-1 level decreased significantly(9.52% vs 22.86%,P<0.05;8.11% vs 22.86%,P<0.05). Compared with the thrombus aspiration group, thrombus aspiration + tirofiban group the proportion of patients with TIMI3 and TMP3 level tended to increase, but the difference was not statistically significant (P> 0.05).2. Compared with the control group, the proportion of patients with 50% ST segment declined after 2 hours in thrombus aspiration group and the thrombus aspiration + tirofiban group were significantly highe(r49.7% vs 21.4%,P<0.05;56.8% vs 21.4%,P<0.05), while the thrombus aspiration group and the thrombus aspiration + tirofiban were no significant difference (P> 0.05). During hospitalization, compared with the thrombus aspiration group and the control group, CK-MB peak reduced(167.7±82.4 vs 285.7±69.2,P<0.05;167.7±82.4 vs 289.1±76.1,P<0.05), cTnI peak decreased(27.2±35.9 vs 54.2±40.3,P<0.05;27.2±35.9 vs 63.7±49.7,P<0.05), hs-CRP peak decreased(26.4±20.8 vs 64.0±29.1,P<0.05;26.4±20.8 vs 73.6±33.5,P<0.05) and CK-MB peak time(9.0±6.7 vs 14.1±3.4,P<0.05;9.0±6.7 vs 13.2±5.2,P<0.05), cTnI peak time(10.1±6.3 vs15.3±4.8,P<0.05;10.1±6.3 vs 14.5±8.6,P<0.05),hs-CRP peak time (31.6±17.5 vs 72.9±30.1,P<0.05;31.6±17.5 vs 76.8±38.4,P<0.05)in thrombus aspiration + tirofiban group all advanced, the difference was significance. During hospitalization , compared with thrombus aspiration group and the control group, thrombus aspiration + tirofiban group the incidence of myocardial infarction again and death was decreasing, but not statistically significant (P> 0.05).3. 1 week after PCI , parameters of left ventricular function in patients of thrombus aspiration + tirofiban group were better than thrombus aspiration group and the control group, but the difference was not statistically significant. 6 months after PCI, functional parameters, as WMSI, in patients of the three groups improved more than witch at 1 week after surgery, and 6 months after PCI ,WMSI in thrombus aspiration + tirofiban group was significantly lower than the thrombus aspiration group and the control group (1.17±0.09 vs 1.43±0.12,P<0.05;1.17±0.09 vs 1.56±0.11,P<0.05), as so as LVEF was higher(57.7±10.3 vs 52.4±9.3,P<0.05;57.7±10.3 vs 50.7±5.5,P<0.05), and LVESVI, LVEDVI also to improve compared with the thrombus aspiration group and the control group.4. Follow-up 1 month and 6 months, compared with the control group, MACE and cardiac mortality rate in the thrombus aspiration group and the thrombus aspiration + tirofiban group were reduced, but the difference was not significant (P > 0.05).Conclusion1. Treatment application of the thrombus aspiration technology during PPCI in patients with acute myocardial infarction can reduce the thrombus load ,increase the level of myocardial perfusion immediately after surgery, and improve cardiac function and clinical outcomes of the recent.2. Early preoperative platelet GPⅡb /Ⅲa receptor antagonist (tirofiban) can further reduce microcirculation thrombosis and embolism, inhibit inflammation after thrombectomy , improve cardiac function and ventricular remodeling, thereby improving clinical outcomes .