And Research Tirofiban Intervention Levels In Patients With Acute Coronary Syndrome Platelet Microparticles

Objective:1. To investigate the level of platelet microparticles(PMPs) in the coronary artery in patients with acute coronary syndrome by using flow cytometry, and explore its relationship with the development of coronary heart disease and its mechanism.2. To investigate the effect on platelet activity and short time clinic benefit of intracoronary or intravenous tirofiban bolus administration to patients with acute ST-segment elevation myocardial infarction undergoing emergency interventional treatment.Methods:1. PART ⅠSelected52patients diagnosed with AMI undergoing emergency PCI: STEAMI28cases,NSTE-ACS24cases,and20patients diagnosed with SA and20normal coronary artery patients proved by the coronary artery angiograph. Extract platelet poor plasma from coronary blood.Added the CD61-PE fluorescent antibodies to mark the platelet microparticle and0.82um standard microspheres,then analysis of the relative number of PMPs by the flow cytometry.2. PART ⅡSelected90patients with acute ST-segment elevation myocardial infarction undergoing emergency interventional treatment, randomly divided into the intracoronary group(intracoronary tirofiban10ug/kg bolus then0.15ug.kg-1.min-1intravenous continuous infusion for36h,30cases), intravenous group (intravenous tirofiban10ug/kg bolus then0.15ug.kg-l.min-1intravenous continuous infusion for36h,30cases) and control group (without tirofiban,30cases). The level of PMPs were assessed before tirofiban infusion,at10min and24hours after tirofiban infusion,and at12hours after stopping tirofiban infusion by the flow cytometry. Clinical and angiographic features were recorded and analyzed.Results:1. The level of PMPs of STEAMI group(8.9%±3.3%)%and NSTE-ACS group (7.8%±2.4%) were higher than the SA group (5.8±2.0)%and the normal group(5.9%±2.6%)(P<0.05,respectivly). The level of PMPs between STEAMI Group and NSTE-ACS group, between the SA group and normal coronary group were similar (P>0.05,respectivly).2. There was no significant difference in baseline of PMPs between intracoronary group, intravenous group and control group (P>0.05). The level of PMPs were significantly lower in intracoronary(3.6%±2.3%) and intravenous group (5.1%±2.7%) compared with control group(6.7%±3.2%)(P<0.01) at lOmins after tirofiban infusion. The PMPs were also lower in intracoronary group than intravenous group(P=0.02). At24hours after tirofiban infusion,the PMPs of intracoronary and intravenous group was similar(P>0.05) and was significantly higher than control group(P=0.02). PMPs was similar at12after stopping tirofiban use among the3groups(P>0.05).3. Intracoronary group were superior to intravenous group and control group in terms of TIMI flow grade(P=0.03VS P<0.01) and TIMI myocardial perfusion grade(P=0.02VS P<0.01) immediately after PCI.MACEs rate in intracoronary group was lower than control group (P=0.03).And MACEs rate between intracoronary group and intravenous group, intravenous group and control group were similar(P>0.05, respectivly). The incidence of bleeding events among3groups was similar.Conclusion:1. The level of PMPs in ACS patients increased significantly, but did not increase significantly in SA patients,suggesting that PMPs might participat in the occurrence and development of coronary heart disease. Its mechanism may be the activation between PMPs and platelet, led to the acceleration of the process of atnerosclerosis.And PMPs can be used to the early detection of high-risk ACS patients.2. Intracoronary tirofiban compared to the intravenous group, can effectively reduce the number of PMPs in patients with acute ST-segment elevation myocardial infarction undergoing emergency interventional treatment, achieve the purpose of the inhibition of activated platelets quickly,and reduce total MACEs events rate, but did not increase the risk of bleeding.