| Purpose:To analysis and evaluate the clinical efficacy and safety of tirofiban and eptifibatide in patients with STEMI.We selected,The results of coronary angiography showed that the target lesions intravascular thrombus loading is heavier in patients with STEMI.In the process of emergency PCI,We prefer to use a bolus catheter to draw a thrombus.And then we applied tirofiban or eptifibatide to the target lesion.We observed and compared the difference of thrombolysis in myocardial infarction(TIMI),TIMI myocardial perfusion grade(TMPG),corrected TIMI Frame Count(CTFC),bleeding complications,the happening of major cardiac adverse events(MACE)30 days after PCI,the patient's left ventricular ejection fraction(LEVF)and left ventricular end-diastolic diameter(LVDd)6 months after PCI.MethodsA total of 120 hospitalized patients with STEMI who were admitted to the Department of cardiovascular medicine in Subei people's Hospital(affiliated with Yangzhou University)from January 2015 to February 2016 were selected.After admission,all patients received a joint antiplatelet therapy with a loading dose of aspirin(300mg)and clopidogrel(600mg).All patients The results of emergency coronary angiography showed that the target lesions intravascular thrombus loading is heavier in patients with STEMI.They all agreed to implement emergency PCI and percutaneous catheter thrombus aspiration.According to the standard of the prospective study,We divided the patients into a control group and observation group.the control group:the simple bolt pumping group(group 1);the experimental group was divided into two groups according to the use of different GP? b/?a receptor antagonists drugs:pumping plug-Application of intracoronary tirofiban group(Group 2)and thrombolytic-intracoronary administration of eptifibatide group(group 3).The control group has 40 patients.there is no special treatment to give after percutaneous catheter thrombus aspiration.The observation group was divided into eptifibatide group(n=40,after the extracting of thrombus aspiration,180 ug/kg of eptifibatide was applied by thrombus aspiration catheter,after 2 to 3 min bolus injection followed a constantly intravenous pumping for 36 hours with the dripping speed 0.2ug/kg min)and tirofiban(n=40,after the extracting of thrombus aspiration,10 ug/kg of eptifibatide was applied by thrombus aspiration catheter with injection for 2 to 3 minutes,and then constantly intravenous pumped for 36 hours with the dripping speed 0.15ug/kg·min).At the same time,All the patients of the 3 groups were given the anticoagulant therapy(usually used for 5 to 7 days according to the coagulation convention and Blood cellanalysis)by Subcutaneous injection of low molecular weight heparin(Enoxaparin 0.75?1.00mg/kg)and combined with antiplatelet therapy with a dose of aspirin(300mg)and clopidogrel(75 mg/d)lasted for 1 year.The patients was followed up for 6 months,we recorded the baseline data of the 3 groups and made a comparsion between them in the aspects of thrombolysis in myocardial infarction(TIMI),TIMI myocardial perfusion grade(TMPG),corrected TIMI frame count(CTFC),bleeding complications,the happening of major cardiac adverse events(MACE)30 days after PCI and the patient's left ventricular ejection fraction and left ventricular end-diastolic diameter 6 months after PCI.All data were analyzed by SPSS 19.0 software.When P was less than 0.05,the difference between the data was considered statistically significant.Results1.Comparison of basic data of the three groups of patientsThe selected 120 patients were diagnosed with STEMI,65 males,and 55 females,the average age was 61.46 ± 10.30 years old,The control group:simple thrombolysis group(group 1,n = 40),The experimental group:thrombectomy plus intracoronary administration of tirofiban group(group 2,n = 40)and thrombectomy plus intracoronary administration of eptifibatide group(group 3,n = 40).There were no statistically significant differences in age,sex,smoking history,alcohol history,hypertension,diabetes,dyslipidemia,white blood cell count,MPV,PDW,FIB,PLT,IRA among the three groups of patients.2.The Comparision of TIMI?CTFC and TMPG after stent placement inthepatient being given tirofiban or eptifibatide through the thrombus aspiration catheter and Before and after stent placement.Before given tirofiban or eptifibatide through the thrombus aspiration catheter and Stent placement,the 3 groups had no significant difference in the proportion of TIMI(P>0.05).After thrombolytic catheter administration of tirofiban or eptifibatide and implantation of thestent,in patients with TIMI 3,group 3 were recovered better than group 2,group 2 were better than group 1,and There were significant differences between the three groups(P<0.05).The CTFC values of group 2 and group 3 were significantly different from those of group 1(P<0.05).But there were no significant differences between group 2 and group 3(P>0.05).After thrombolytic catheter administration of tirofiban or eptifibatide and implantation of the stent.In the proportion,TMPG 3 group 3 Is greater than group 2,and group 2 is greater than group 1,there was a significant difference among those groups(P<0.05).3.The comparison of Left ventricular systolic function and left ventricular end diastolic diameterThe Echocardiography was carried out in less than 24 hours after admitted to our hospital and the results revealed:among the 3 groups there was no significant statistical difference(P>0.05)in LVEF and LVDd.Echocardiography was reviewed at 6 months postoperatively.the results showed that:as to the LVEF and LVDd,group 3 were better than group 2,group 2 were better than group 1,and there was a statistically significant difference between the two groups(P<0.05).4.The comparison of the happen of MACEs IncidentThe incidence of total MACEs,including cardiac death,recurrent MI,angina pectoris,target vessel revascularization(TVR),malignant arrhythmia,heart failure,bleeding,slow Flow and no flow and so on.Group 1:10 cases of heart failure,2 cases of malignant arrhythmia,3 cases of typical angina pectoris,2 cases of slow blood flow have happened in the control group.The happen of MACEs in the two experimental groups were as follows.Group 2:2 cases of heart failure and 1 cases of typical angina pectoris and 2 cases of gingival bleeding were happening.Group 3:1 cases of heart failure,1 case of malignant arrhythmia,1 case of typical angina,2 cases of gingival bleeding were happening.In the experimental group,there were no adverse events such as no-reflow,hemorrhage,and thrombocytopenia The total incidence of MACE was lower in group 3 or group 2 than group 1.There was a statistically significant difference in the probability of occurrence of MACE Within 30 days after surgery between the group 2 and the group 1(P<0.05),so does the group 3.There was no significant difference in the probability of MACE between the group 2 and the group 3(P>0.05).Conclusion:1.During the process of emergency PCI In patients with STEMI whose coronary angiography suggest severe thrombus-bearing,the experimental group used conventional dose of tirofiban or eptifibatide and compared with the control group,both of them can improve the coronary artery TIMI blood flow classification,Increase the level of myocardial reperfusion in the infarcted region,reduce the incidence of coronary artery slow flow and no-reflow phenomenon,thereby improving the patient's cardiac function,reduce the incidence of MACE events 30 days after the surgery,and meanwhile did not increase the happens of complications such as Thrombocytopenia and massive haemorrhage.2.During the process of emergency PCI In patients with STEMI whose coronary angiography suggests severe thrombus-bearing.The use of eptifibatide has more advantage than tirofiban in the aspects of improving the coronary artery TIMI blood flow classification,Increasing the level of myocardial reperfusion in the infarcted region,reducing the incidence of coronary artery slow flow and no-reflow phenomenon,improving the patient's heart function.However,there was no significant difference between eptifibatide and tirofiban in reducing the incidence of MACE events 30 days after the surgery and drug safety. |
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