| Objective: To explore the differences of clinical efficacy of the platelet glycoprotein IIB/IIIA receptor antagonist(GPI)--tirofiban which was used by three different ways(coronary artery and vein, simple intravenous, do not use) in the patients of acute coronary syndrome(ACS) who underwent coronary artery intervention(PCI).Observe the three groups of patients with postoperative myocardial blood vessel reperfusion, microcirculation improvement, as well as postoperative thrombocytopenia, bleeding risk and other drug safety situation.Methods: From January 1, 2014 to October 1st,2014 in our department of cardiology of Hainan Provincial People's Hospital, 159 consecutive hospitalized patients with ACS who had indications for PCI and the thrombus lesion were confirmed by coronary angiography were enrolled in this study. According to the order of admission and refer to the random number table, the patients were randomly divided into 3 groups. A group: 58 cases were intravenous injected with tirofiban; B group:49 cases were directly injected into coronary artery and intravenous injected with tirofiban;C group: as blank control group the 49 cases were intravenous injected with normal saline. All selected patients were in accordance with the 2012 /AHA(American Heart Association) ACC(American Heart Association) guidelines for diagnostic criteria, and were in compliance with the GRACE score with moderate risk or high risk. All patients were given aspirin loading 300 mg, clopidogrel 300 mg oral administration before operation. The long-term use of aspirin 100mg/Day, using clopidogrel 75mg/Day to maintain one year,and low molecular weight heparin 0.5-1mg/kg/12 h,by subcutaneous injection and continuouing 5-7 days. Other medication were including ticargrelor, atorvatatin, metoprolol, trimetazidine and so on which were used as the two level prevention of coronary heart disease. To compare the three groups of patients with TIMI flow grade, slow flow and no reflow, the incidence of stent thrombosis, postoperative 24 hours ECG ST segment fall rate, after 72 hours of myocardial enzyme(c Tn T, CK-MB, Hfabp), NT pro BNP, D 2 poly body recovery, within 24 hours and medication during and after discontinuation of platelet and hemoglobin decreased significantly and bleeding, postoperative after 1 to 6 months of major cardiovascular events(MACE)(including: recurrent angina, myocardial infarction, cerebral stroke, death and target vessel blood transport reconstruction). Statistical analysis of all data was using the SPSS 20 edition software.Results:?There was no significant difference in the clinical data between the three groups;?Compared with group A and group B,the thromboembolic events incidence rate had no significant difference between the two groups(6.90%, 4.1%, P = 0.42 > 0.05); Compared withgroup A,the rate of thromboembolism in the group C was significantly increased(23.08% and 6.90%, P = 0.02); Compared with group B, thromboembolic events occurred rate in the group C increased more obviously(23.08%, 4.1%, P = 0.00);?The c Tn T of postoperative: the arrival of peak of group B is significantly ahead, and the patients in group A and group C were without significant difference; The CK-MB of postoperative: among the three groups, the patients in B group had the best recovery; Group A was secondary and group C was the worst; Comparison of the positive rate of HFABP: the positive rate of B group was the lowest, group A was secondary and group C was the highest; The recovery of NT-pro BNP: group A and group B were not statistically different(P=0.128), but the recovery was better than the group C(P=0.00);The recovery of D-dimer: comparison of group A and group C(89.66%, 65.38%), P = 0.002, A group was significantly better than the C group; Compared with group A and group B, P=0.336, there was no significant difference between the two groups, and B group was significantly better than the C group;(P = 0.00). Postoperative ECG ST segment decreased 70%: there was no significant difference in A group and B group(P=0.09); And A group recovered better than the C group(P=0.02). B group of patients with postoperative ECG ST recovery is better than the C group(P=0.00).?To observe thrombocytopenia, hemoglobin reduction and bleeding when using tirofiban and 24 hours after withdrawal, there was no significant difference between the three groups.?To observe the occurrence rate of MACE six months after surgery: B group was the lowest, group A was secondary and group C was the highest; This results showed that the clinical curative effect of the treatment of tirofiban not only was effect in the perioperative period,and has a great significance to the long-term clinical efficacy.Conclusion: patients with ACS of PCI patients, whether were given tirofiban by intravenous infusion or coronary intravenous administration, the coronary artery reperfusion, improve the microcirculation, and the occurrence of MACE within six months after the operation were better than not to use this medicine.And the the risk of bleeding was not increasing; At the same time, due to local blood drug concentration can be increased rapidly, and can improve coronary reperfusion effectively, especially for slow flow and no reflow in the patients with coronary artery, the patients of using tirofiban by coronary artery and vein, can significantly improve TIMI blood flow,and reduce the occurrence of perioperative thrombotic events. And the recovery of cardiac function of the patients of using tirofiban by coronary artery and vein, were significantly better than the patients using by intravenous. |
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