| Objective: This study was aimed to evaluate the effect of perioperativeand long-term and safety in drug eluting stents joint tirofiban,drug elutingstents and bare metal stents in patients with acute ST segment elevationmyocardial infarction performed primary percutaneous coronary intervention(PCI) by retrospectively analyzing the result of the TIMI coronary flowlevel,myocardial blush perfusion(TIMI myocardial perfusion grading(TMPG),Corrected TIMI Frame Count (CTFC）,the result of heart function1week and6months measured with echocardiography after percutaneouscoronary intervention PCI, the incidence of intrastent thrombosis,bleedingcomplications during hospitalization and major adverse cardiacevents(MACE).Methods: Total of203pateints with acute ST-segment elevationmyocardial infarction were enrolled into this study from February2001toAugust2006.All of the patients were divided into three groups,68patientswere divided into group A(drug eluting stents joint tirofiban group),including56male and12female, average ag（e53±8.3yrs）；60patients were divided intogroup B(drug eluting stents group),including50male and9female, averageage（58±11.3yrs）；75patients were divided into group C(bare metal stentsgroup),including64male and11female, average age （55±10.3yrs）.All of thepatients enrolled into this study were explicitly diagnosted with acuteST-segment elevation myocardial infarction in line with the ACC/AHA criteriafor STEMI：(1) typical angina symptoms persist above30minutes, that cannot be relieved by sublingual nitroglycerin (2) ECG showed ST-segmentelevation in two or more limb leads>0.1mV, precordial leads ST-segmentelevation>0.2mV or emerging left bundle branch block in ECG revealed adjacent leads (3) the peak value of CK, CK-MB were two times upper thanthat of normal, and had a dynamic evolution with troponin I positive (4) timeafter the onset was within12hours. Exclusion Standard：(1) patients with Ahistory of dynamic bleeding recently, peptic ulcer for example (2) patientswith a history of ischemic stroke or cerebral hemorrhage recently (3) patientswith severe liver or kidney disease (4) Coagulation disorders (5) Heartfunction of Killip grade4(6) Aortic dissection (7) Advanced tumor. Theinformed consent was signed and all of the patients were administered Aspirin300mg, clopidogrel300mg befor PCI. The Infarct-related artery(IRA),whichwas explicitly diagnosted with CAG, was treated immediately with PCI whenthe degree of diameter stenosis exceeded75%by using quantitative coronaryanalysis(QCA). In group A, tirofiban was administered with10μg/kg loadingdose in3min bolus, then continuously intravenous infusion of0.15μg/(kg.min)for36-48hours. The conventional basis drug after PCI: Aspirin300mg onetime per day and reduce to100mg one time per day after a month then persistlong-term,Clopidogrel75mg one time per day for12months,low molecularweight heparin5000u was injected subcutaneously two times per day for7days.adjuvant drug such as nitroglycerin,ACEI,β-blocker、statin and so onwere administrated in all the patients if there was no contraindication. TheTIMI coronary flow level,myocardial blush perfusion (TIMI myocardialperfusion grading,TMPG),Corrected TIMI Frame Count (CTFC)wereobserved and analyzed with QCA, CK-MB peak time and value werecalculated, left ventricular end-diastolic volume (LVEDV), left ventricularend-systolic volume(LVESV),left ventricular ejection fraction (LVEF) wereanalyzed with echocardiography of GE VIVID71week and6months afterPCI. Percentage of diameter stenosis in IRA was measured and calculatedbefore and after PCI immediately.coronary angiography late loss andincidence of in-stent restenosis Six months after PCI, the incidence of stentthrombosis and perioperative bleeding complications were analyzed.Majoradverse cardiac events(MACE),which including cardiac death, malignantventricular arrhythmia, recurrent myocardial infarction,target lesion revascularization, were followed up for6months and6years respectively. Allof the data were analysised with SPSS13.0packages, and P<0.05wasconsidered with significant difference.Result:1Comparison of the basic clinical information among the three groups:There was no significant statistical difference among the three groups insex,age,hypertension,diabetes mellitus,Lipid levels, smoking history, familyhistory,time from symptom onset to balloon and distribution of IRA(P>0.05),LAD(45.7％VS43.3％VS48.0％,LCX13.2％VS16.7％VS16.0％，RCA41.1％VS40.0％VS36.0％).2Comparison of the results of CAG and PCI among the three groups:TIMI3flow before PCI among three groups:group A (4.4%), groupB(3.4%) group C (5.3%); TIMI2flow: group A (10.3%), group B(10.0%),group C (12.0%); TIMI0-1flow group A (85.3%), group B (86.6%), groupC(82.7%).The percentage of TIMI3flow. was no significant statisticaldifference among the three groups.The percentage of TIMI3flow was withincreasing trend in group A after PCI (94.1%VS85.0%VS86.7%，P>0.05)but no significant statistical difference among the three groups.．Percentage ofTMPG3before PCI was5.9%in group A,5.0%in group B and6.7%in groupC,percentage of TMPG2was10.3%in group A,10.0%in group B,12.0%ingroup C, and percentage of TMPG0-1was83.8%in group A,85.0%in groupB,81.3%in group C,which indicated no significant statistical differenceamong the three groups before PCI(P>0.05). The percentage of TMPG3ofgroup A after PCI was higher than that of the group B and groupC(86.8%vs56.7%vs57.3%， P<0.05).There was no significant statisticaldifference between the group B and group C (P>0.05)．The CTFC of group Awas fewer than that of group B and group C (25.5±6.3vs32.2±7.5vs33.4±5.8，P<0.05)after PCI,which was no significant statistical difference betweengroup B and group C (P>0.05).The percentage of no-reflow according toTMPG criterion in group A was fewer than that in group B and group C（2.4%vs13.3%vs12.7%,P<0.05)The percentage of intrastent thrombosis of group A was fewer than that of group B and group C,but there was no signif-icant statistical difference among three groups（0.03%vs0.07%vs0.04%,P>0.05）.3Comparison of heart function among the three groups:There was no significant statistical difference in LVEF,LVEDV andLVESV in three groups1week after PCI(46.7±9.7vs42.4±6.3vs43.1±7.1；118.3±20.2vs120.6±20.8vs121.7±21.1;75.5±12.4vs78.4±13.3vs76.2±14.2，allP>0.05)，A group32cases (47.7%), B group25cases (41.7%) and C group31cases (41.3%) were review of cardial function6month after PCI.The valuesof LVEF,LVEDV and LVESV were obviously better6months after PCI ingroup A than that in group B and group C (62.7±8.5vs53.4±4.8vs52.8±5.2；108.2±12.3vs118.7±13.5vs117.5±11.1;61.8±8.8vs71.2±9.4vs73.5±8.2,all P<0.05). There were no significant statistical difference between groupB and group C (P>0.05)．4Comparison of the level of myocardial injury markers among the threegroups:The peak value of CK—MB was obviously less in group A than in groupB and group C (235.6±57.8vs283.5±67.7vs289.3±89.1U/L) P<0.05)andthe time of CK—MB peak value was earlier than that in group B and group C(9.2±1.2vs12.4±1.5vs11.9±1.7hours,P<0.05)．There were no significantstatistical difference in the peak value and time of CK-MB in group B andgroup C (P>0.05).5Comparison of restenosis rate and later lose among the three groups:The degree of diameter stenosis was no significant difference among thethree groups(92士6.2％VS89士8.4％VS88士5.7％,P>0.05)according toCAG. There was no significant statistical difference in the degree ofimmediately diameter stenosis and early gain in three groups after PCI(7士2.5％VS8士3.2％VS8士5.4％;2.5士0.7VS2．6士0．4VS2．7士0．5mm,all P>0.05) A group32cases (47.7%), B group25cases (41.7%) and C group31cases (41.3%) were review of CAG6month after PCI.The value of later losswas obviously lower in group A and group B than that in group C(0.15士 0.06vs0.16士0.04vs0.53士0.08mm P<0.05) according to CAG performed6months after PCI,which was no significant statistical difference between groupA and group B (P>0.05)).The incidence of intrastent restenosis rate wasobviously lower in group A and group B than that in group C（8.5％VS8.2％VS14.6％all P<0.05）according to CAG6months after PCI, which was nosignificant statistical difference between the group A and group B (P>0.05)．6Comparison of the incidence of MACE during the hospitalization andfollow-up among the three groupsThe major adverse cardiovascular events such as cardiac death,reinfarction, malignant arrhythmia, target lesion revascularization did nothappen during the hospitallization, which was lower in group A than that ingroup B and group C during6months’follow-up, but was no significantstatistical difference(P>0.05) Six years follow-up rate of group A36.8%;groupB45.0%;group C40.0%.The combining use of tirofiban and drug-eluting stentsignificantly reduced MACE rate after6years.There was no significantstatistical difference in reinfaction, cardiac death, and asymptomatic survivalrate among three groups after6years.The revascularization rate in group Aand group B was obviously lower than that in group C（6.8%vs8.4%vs16.7%P<0.05）, which was no significant statistical difference between the group Aand group B (P>0.05)．7Comparison of the incidence of hemorrhage complication among the threegroups:There was no significant statistical difference in the percentage ofhemorrhage complication among group A, group B and group C(4.4%vs3.3%vs2.7%P>0.05). There were no serious bleeding events during thehospitalization.Conclusions:1The combining use of tirofiban and drug-eluting stent can increase tissueperfusion, reduce no-reflow, significantly improve heart function6monthsafter PCI in patients with acute myocardial infarction after PCI.2Drug-eluting stents joint hydrochloride Tirofiban and Drug-eluting stents can significantly reduce the intrastent restenosis and revascularizationrate6months after PCI.3No significant differences in incidence of MACE among Drug-elutingstent joint hydrochlorid Tirofiban group, drug-eluting stent group and barestent group during hospitalization and6month after PCI.4Drug-eluting stent joint hydrochlorid Tirofiban does not increaseperioperational bleeding complications. |
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