| Objective: In this prospective study,we will observe and compare the difference of revascularization circumstances,thrombolysis in myocardial infarction(TIMI) flow, Corrected TIMI Frame Count(CTFC), TIMI myocardial perfusion grade(TMPG), bleeding complications, thrombocytopenia, left ventricular ejection fraction(LVEF),ADP-induced platelet aggregation and major adverse cardiac events(MACE,including severe heart failure, malignant ventricular arrhythmias, cardiac death,reinfarction and target vessel revascular cularization) by tirofiban and eptifibatide in patients with acute non ST segment elevation myocardial infarction undergoing percutaneous coronary intervention.Methods:One hundred and twenty-five patients(93males,32 females,he average age of 61.25±4.97 years old)who suffered from first NSTEMI and undergoingt coronary angiography(CAG) and PCI in the Second Hospital of Hebei Medical University from May 2013 to January 2014 were enrolled in this study. Eligible patients were randomly divided into 2groups: tirofiban group(62patinents) and eptifibatide group(63 patients), and who were admitted to: 300 mg aspirin and 300 mg clopidogrel orally for the first time, then 100 mg aspirin and 75 mg clopidogrel every day, subcutaneous injection enoxaparin sodium 0.75-1.0mg/kg, two times a day and other auxiliary medications such as nitrates, ACEI/ARB, statins, β-blocker, CCB and so on, which is carefully selected according to the clinical situation. The tirofiban group were assigned to receive tirofiban 10ug/kg bolus intravenously over 30 min,followed by infusion at 0.15ug/kg/min.The other patients in eptifibatide group were received eptifibatide 180μg/kg bolus intravenously followed by infusion at 2.0ug/kg/min.Study medication was initiated before PCI and administered 24 hours.Recorded and compared the difference of of baseline clinical characteristics, ADP-induced platelet aggregation rate before and after PCI, TIMI flow grade, corrected TIMI frame count(CTFC), TIMI myocardial perfusion grade(TMPG), left ventricular ejection fraction(LVEF) before and, when 30 days after PCI,bleeding complications, the incidence of thrombocytopenia, the difference of MACE of patients when 30 days after PCI between tirofiban group and eptifibatide group.SPSS 13.0 was used for analyzing data, and P < 0.05 was considered statistically significant.Results:1 There were 125 patients was enrolled into our study(93 male and 32 female,average age was 61.25±4.97 years old) and there were divided into two comparison group: tirofiban group(n=62) and eptifibatide group(n=63).2 Comparison of basic clinical information:There were no significant difference between the two groups in age, gender distribution, weight, history of smoking and drinking, hypertension, diabetes, hyperlipidemia, hemoglobin, platelet count, global registry of acute coronary events(GRACE) score,IRA, ADP-induced platelet aggregation rate and LVEF at admission.3 Comparison of TIMI flow grade, corrected TIMI frame count(CTFC), TIMI myocardial perfusion grade(TMPG) after stenting procedure:There is no difference in the rates of IRA and TIMI grade between groups before PCI(all P > 0.05).After PCI treatment,the rate of TIMI flow grade 3 in tirofiban group was higher than that in eptifibatide group(88.71%vs74.60%,P<0.05),and the CTFC in tirofiban group was slightly lower than eptifibatide group,but there was no significant difference between in the two groups(24.56±4.25vs25.25±4.35,P>0.05). While the percentage of TMPG 3 after PCI in tirofiban group was higher than in eptifibatide group(82.26%vs 66.67%,P<0.05).4 Comparison of ADP-induced platelet aggregation rate between the groups:There was no significant between the groups in ADP-induced platelet aggregation rate before PCI(51.95±7.35% vs 52.96±8.18%;P>0.05), the two groups had significant decline in mean platelet aggregation from baseline measured immediately after PCI(3.03±0.94%vs51.95±7.35% 、3.39±0.91%vs52.96±8.18%, P<0.05), but tirofiban group was better than eptifibatide group(3.03±0.94% vs 3.39±0.91,P<0.05).18 hours after PCI, The ADP-induced platelet aggregation rate in tirofiban group was lower than eptifibatide group(13.69±5.55% vs 16.09±6.53, P < 0.05),and also had significant decline compared with baseline. the appearance sustained until 2 hours after drug discontinuance(17.66±7.43% vs 20.81±7.28%,P<0.05), and had significant decline compared with baseline as well(17.66±7.43% vs51.95±7.35%、20.81±7.28% vs52.96±8.18%, P<0.05).5 Comparison of bleeding events and incidence of thrombocytopenia: The puncture site hematoma were observed in 2 patiens from tirofiban group and 1patient from eptifibatide group, there were 3 patients in tirofiban group and 1 patient in eptifibatide group had gum bleeding, meanwhile,1 patient had hemorrhage of digestive tract in tirofiban group. In general,there were no significant difference in the percentage of hemorrhage complicationbetween the groups(9.68% vs 3.17%,P>0.05). And there were no thrombocytopenia happened in both groups.6 Comparison of LVEF before and after PCI:There were no significant in LVEF before and after PCI between the groups(45.58±7.78%vs45.05±7.70%、51.63±8.10%vs50.81±7.38%, P>0.05),compared with the baseline,there were significant raise in mean LVEF at 30 days after PCI(51.63±8.10%vs45.58±7.78%、50.81±7.38%vs45.05±7.70%%, P<0.05).7 Comparison of the incidence of MACE in 30days:there were heart failure and malignant ventricular arrhythmias 1 cases each in tirofiban group,and eptifibatide group appeared malignant ventricular arrhythmias in 1 case. There were no significant differences of MACE in 30 days between two groups.Conclusion:1 Application of Regular dose of tirofiban and eptifibatide can Obviously improve coronary blood flow, increase the level of myocardial perfusion during PCI, and tirofiban was better than eptifibatide. In improving cardiac function, tirofiban was similar to eptifibatide.2 ADP-induced platelet aggregation rate in tirofiban group was lower than eptifibatide group after PCI、18 hours after PCI and 2 hours after drug discontinuance.3 Application of Regular dose of tirofiban or eptifibatide dose not increase the risk of major bleeding events and MACE during the PCI... |
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