Application Of Intracoronary Tirofiban Administration In Patients With Acute ST Elevation Myocardial Infarction Under Percutaneous Coronary Intervention

Background: It is still debatable whether intracoronary(IC) administration of tirofiban is more beneficial to intravenous(IV) administration for patients with acute ST elevation myocardial infarction undergoing emergency percutaneous coronary intervention(PCI).Methods: We performed a randomized controlled clinical trial. A total of 62 patients with acute ST-segment elevation myocardial infarction(STEMI)were randomly divided into treatment group(intracoronary tirofiban administration, 32 cases) and control group(intravenous tirofiban administration, 30 cases). The primary outcomes were Serum levels of Interleukin-6(IL-6) and soluble CD40 ligand(sCD40L) were measured before PCI and 1h,2h,24 h after PCI. The second outcomes included Thrombolysis and Angioplasty in Myocardial infarction(TIMI) frame grade 3count, ST-segment resolution(STR), left ventricular volumes and ejection fraction(LVEF),30-day and 6-month major adverse cardiac events(MACEs) and complications such as hemorrhage and thrombocytopenia were conducted.Results: Intracoronary tirofiban administration resulted in a higher rate of coronary blood flow TIMI frame grade 3 count(93.8% vs 90%,p>0.05)but doesn’t reach statistic difference. The rate of completed STR, 2 hours after PCI(96.9%vs 73.3%,p<0.05), better LVEF 7 days after PCI(0.48±0.05 vs 0.53±0.06,p<0.05); the sinus levels of IL-6 intracoronary group is lower than intravenous group in 2hours after PCI(53.65±5.19 vs 56.43 ±5.08,p<0.05), and previously lower in 24 h after PCI(33.48 ±5.11 vs 45.53±5.33,p<0.01); the sinus levels of sCD40 L intracoronary group is lower than intravenous group in 2hours after PCI(53.65±5.19 vs 56.43 ±5.08,p<0.05),and previously lower in 24 h after PCI(33.48 ±5.11 vs 45.53±5.33,p<0.01); Patients treated with intracoronary tirofiban had a trend toward less MACEs at 30 days than intravenous group but doesn’t reach statistic difference(3.1%vs6.7%,p>0.05), and less MACEs at 6 months than intravenous group(3.1%vs23.3%,p<0.05). No significant difference was observed in the appearance of thrombocytopenia(9.4%vs6.7%,p>0.05), and bleeding complication(9.4% vs6.7%,p>0.05) between the 2 groups.Conclusion: IC administration of tirofiban in patients with STEMI under PCI can reduce theinflammatory response and platelet activation, by which improve coronary blood circulation,significantly increase target coronary flow and myocardial reperfusion without increasing the risk of bleeding complication. So the emergency treatment of acute STEMI PCI in perioperative period of intracoronary tirofiban is safe and effective.