Effect Of Tirofiban Injection Using A Homemade Balloon Delivery System With Side Holes On The Reperfusion In Patients With Acute Myocardial Infarction During Percutaneous Coronary Intervention Procedure

Objective To evaluate the effect of tirofiban injection using a homemade balloon delivery system with side holes on the reperfusion in patients with acute myocardial infarction(MI)during percutaneous coronary intervention(PCI)procedure and its impact on short-term clinical prognosis.Methods From a sample of ST-segment elevated myocardial infarction(STEMI)patients who underwent emergency PCI treatment in the cardiology departments of Shanghai Jing’an District Central Hospital and Chang Hai Hospital affiliated to the No.2 Military Medical Hospital from November 2013 to December 2014,randomly assigned the patients into a control group(tirofiban coronary injection using guide catheter)and a study group(tirofiban coronary injection using a homemade balloon delivery system).Thrombolysis in myocardial infarction(TIMI)blood flow grade,Corrected TIMI frame count(CTFC),Myocardial blush grade(MBG)and ST-segment resolution rate of related ECG leads were compared,in addition to Troponin I and creatine kinase isoenzyme were also compared before and 2h after PCI.Major adverse cardiovascular events(MACEs)during hospitalization and 1 month,12 months after treatment were also studied along with echocardiography follow-up.Results A total of 53 patients were enrolled,with 27 assigned to the control group and 26 assigned to the study group.There were a total of 44 male patients with an average age of 64.8±2.3 years old.Before the operation,eighteen cases were diagnosed as acute anterior myocardial infarction,32 inferior myocardial infarction,and 3 lateral myocardial infarction.Thirty two patients also had a history of hypertension,15 patients with diabetes mellitus,and 27 with smoking history,4 patients Killip grade ≥3.There was no statistical significance(P>0.05)between the two groups of patients in terms of age,gender and comorbidities.The infarct-related arteries were determined as to the left anterior descending artery in 18 cases,left circumflex artery in 3 cases,right coronary artery in 32 cases.Twenty nine(55%)patients underwent intraoperative catheter thrombectomy and temporary cardiac pacing was applied in 4 patients(8%).Drug-eluting coronary stents were implanted in all 53 patients with a total of 67 stents.The diameter of the coronary stents in the study group was slightly larger than that of the control group(3.18±0.32 mm vs 2.96±0.43 mm,P=0.039).No complications associated with the homemade balloon occurred in the study group.Difference in the TIMI grade 3 blood flow recovery rate after tirofiban injection after balloon inflation and(or)thrombus aspiration between the two groups was not statistically significant(88.9% vs 92.3%,P=0.671).Difference in CTFC between the two groups did not have statistical significance either(26.8±4.6vs 24.6±4.7,P=0.274).As regards MBG 0~1(7/27 vs 5/21)and grade 2~3(20/27 vs 21/26),there was no statistical significance between the two groups(P=0.560)and patients with TIMI flow grade 0~1 were all MBG 0~1.Neither complete declining rate(66.7% vs 65.3%,P=0.922)nor partial declining rate(25.9% vs 30.7%,P=0.922)of ST-segment of related ECG leads before and 2h after PCI showed statistical significance.No statistical difference were observed between the two groups in term of Troponin I and creatine kinase isoenzyme values(P>0.05)2h after the operation.There were 2 deaths during hospitalization(one patient in the control group suffered from persistent hypotension after treatment and died of cardiogenic shock,the other in the study group died of sudden cardiac death,probably from cardiac rupture,the next day after treatment).During the 12 months of follow-up after discharge,4 patients suffered from heart failure(2 in the control group and 2 in the study group),2 patients suffered from angina(1 in the control group and the other in the study group),no myocardial infarction or cardiac death occurred.1 month and 12 months Echocardiography follow-up after treatment showed no statistically significant difference between the two groups(P>0.05).Multifactor Cox regression analysis showed that MBG 0~1(HR1.46,P=0.020,95%CI 1.13~1.92)could be a predictor of major adverse cardiovascular events after reperfusion therapy.Conclusion The homemade balloon device with side holes can be safely used in emergency PCI in acute STEMI patients,but tirofiban coronary injection using the balloon device shows no noticeable effect on the reperfusion,nor does it have any significant impact on the short-term prognosis.MBG 0~1 can be a predictor of major adverse cardiovascular events after reperfusion therapy.Expanded sample size is needed in the further study.