The Comparative Study Of Introcoronary Tirofiban Preoperative Versus Intranperative In Non-ST-segment Elevation Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention Treatment

Background: In patients with moderate-and high-risk non-ST-segment elevationacute coronary syndromes (NSTE－ACS) who undergo early percutaneous coronaryintervention treatment, administration of platelet glycoprotein(GP) IIb/IIIa inhibitorshas been given a grade IIa recommendation based on current guidelines.At the sametime,amount of studies showed that introcoronary tirofiban is a good method to increasethe myocardial microcirculation reperfusion during the procedure and improve theprognosis.However,wether upstream to all patients prior to angiography or deferred forselective use during the procedure is still undetermined.Objective:To determine which strategy would be taken, using tirofibanpreoperative or intranperative in non-ST-segment elevation acute coronary syndromeundergoing PCI.Methods: The study was a prospective, randomized, controlled clinical trial;206patients with moderate-and high-risk NSTEACS were randomly assigned to group Aand group B based on the order of admission. Both of them received the regular therapywith aspirin, clopidogrel and low molecular weight heparin (LMWH). Those who ingroup A received upstream tirofiban treatment before PCI, and group B receiveddeferred selective treatment after angiography. All the patients underwent PCI treatment in48-72hours after admission. Patients who met the indications of emergency PCIwould receive early reperfusion and tirofiban treatment during the operation.TheThrombolysis in Myocardial Infarction (TIMI) flow grade,TIMI Myocardial PerfusionGrade (TMPG) of target artery before and after PCI and the incidence of Major AdverseCardiac Events (MACE) in both groups were compared during hospitalization andfollowed3months. Bleeding complications during treatment were recorded forcomparing the risk of bleeding.Results: More severe patients were involved in group A than in group B (3.92%vs11.54%, P <0.05) during the procedure. The ratio of TIMI grade3in group A andGroup B were75.1%and61.9%respectively (P <0.05),and TMPG3grade in group Awere higher than group B before PCI were61.6%vs33.1%(P <0.05). There were nosignificant difference (P>0.05) on the ratio of TIMI flow grade3between the twogroups after PCI, but group A associated with a significantly better on the ratio ofTMPG2-3(88.3%vs63.5%, P <0.05). The incidence of MACE during hospitalizationand followed3months in group A was a little lower than group B, but the differencewas not statistically significant (P>0.05). The incidence of severe bleeding, slightbleeding and thrombocytopenia were no significant difference (P>0.05) between thetwo groups,while the unimportant bleeding in group A was more than group B (P<0.05).Conclusions: Through upstream use of tirofiban increase the risk of bleedingslightly, however, in patients with moderate-and high-risk NSTEACS who undergo thePCI treatment strategy, upstream tirofiban therapy can reduce the need for emergencyPCI, improve the blood flow of target artery before PCI and supply more blood to themyocardial tissue pre-and post-PCI, should be a optimized strategy. unfortunately,upstream use of tirofiban can’t reduce the MACE of those people during hospitalizationand3months follow-up.