The Clinical Application Research Of Intracoronary Tirofiban In Patients With Acute ST-segment Elevation Myocardial Infarction Undergoing Primary PCI

Objective:1.To discuss the effects of intracoronary injection of platelet glycoprotein Ⅱb/Ⅲa receptor inhibitor tirofiban on coronary blood flow and myocardial tissue-level reperfusion in patients with acute STEMI undergoing primary PCI by analyzing TIMI flow grade and CTFC.2.To discuss the effects of intracoronary tirofiban on inflammatory response and myocardial injury in patients with acute STEMI undergoing primary PCI by measuring the preoperative and postoperative 24 hours of hs-CRP, CK-MB and c Tn I.3.To investigate the recent clinical outcomes and safety of intracoronary tirofiban in patients with acute STEMI undergoing primary PCI by the comparison incidence rate of MACE,bleeding and thrombocytopenia during hospitalization and the incidence rate of MACE in follow-up to 3 months after PCI.Methods:1.We choose 96 patients diagnosed with acute STEMI for the first time who underwent primary PCI in yanan university hospital heart(from March 2013 to December 2014), among which 69 are male, 27 are female. patients were randomly divided into three groups: joint group(tirofiban coronary artery and vein joint application, 34) and vein group(tirofiban vein application, 32) and control group(without tirofiban, 30) only accepted by PCI. patients from all groups were given chew Aspirin 300 mg,oral Clopidogrel 600 mg and atorvastatin 40 mg before primary PCI. Joint and vein group patients, after infarction related artery via the thread(or balloon) completely expansion and appear push forward blood flow, joint group intracoronary injection tirofiban(10ug/kg,3min), vein group intravenous injection tirofiban(10ug/kg,3min),then two groups of patients were at a speed of 0.15ug/kg/min venous continuous pumping for 24 hours. The control group only accept routine PCI without tirofiban.2.We compared three groups postoperative and preoperative TIMI flow grade, corrected TIMI frame count. Hs-CRP, CK-MB and c Tn I were tested preoperative and postoperative for24 hours. Record the bleeding conditions during hospitalization, the incidence rate of thrombocytopenia and major cardiovascular events, the incidence rate of MACE in follow-up to 3 months after PCI.3.statistical analyse: all data were analyzed by SPSS20.0 statistical software package:(1)the measurement data adopt one-factor analysis of variance(F test),P values <0.05 were considered as statistically significant;(2)count data were compared using the chi-square test, two sets of data compare among three by chi-square segmentation method, inspection standard should be 0.0167, P values <0.0167 were considered as statistically significantResults:1.The study selected 96 cases of patients with acute STEMI within 12 hours. There were no statistical difference among the three groups of patients in baseline clinical characteristics, including sex, age, smoking, family history of coronary heart disease, hypertension, diabetes, hyperlipidemia, time from symptom onset to the first ballon expanding, infarct-related artery stents(P>0.05).2.The infarct-related artery of three groups patients were successfully opened after primary PCI. Before PCI, the percentage of three groups TIMI3 blood flow was no statistical difference(P>0.05);The level of TIMI3 blood flow after PCI obviously improved than before, but the percentage of TIMI3 blood flow among three groups was no statistical difference(P>0.05). The rate of CTFC≤27 among three groups after PCI(P<0.05), the rate of joint group CTFC≤27 was higher than vein group and control group(P<0.0167), but there was no statistical difference between vien group and control group(P>0.0167).3.The level of hs-CRP,CK-MB, c Tn I 24 hours after PCI in three groups of patients were higher than before PCI(P<0.05). PCI postoperative 24 hours, joint group and veingroup hs-CRP level were lower than control group(P<0.05); Joint group hs-CRP level was also lower than vein group(P<0.05).the joint group of 24 hours after PCI and vein group CK-MB, c Tn I levels are lower than the control group(P<0.05), there was no statistical difference between joint group and vein group(P>0.05).4. There were no statistical difference among three groups of patients in major cardiovascular events incidence during hospitalization and follow-up to 3 months after PCI(P>0.05);the incidence rate of bleeding and thrombocytopenia in three groups of patients was no statistical difference(P>0.05).Conclusion:1.For emergency PCI patients with acute STEMI, application of intracoronary tirofiban, which can improve tissue-level reperfusion and inhibit the inflammatory response and reduce the level of myocardial injury, without increasing the incidence rate of bleeding events and thrombocytopenia, clinical application has a good security.2.The application of intracoronary tirofiban had not reduce major cardiovascular events incidence during hospitalization and follow-up to 3 months after PCI. its value of the long-term clinical prognosis of patients still needs further follow-up, and large-scale clinical trials to confirm.