Diabetes And Myocardial Infarction Patients Treated With PCI Combined With Tirofiban Study On The Changes Of Molecular Markers

Objective: To investigate the effect of platelet IIB/IIIA receptor antagonist(GPI)tirofiban on prethrombotic state(PTS)molecular markers in patients with acute myocardial infarction(AMI)with Type 2 diabetes(T2DM)undergoing coronary intervention(PCI).The incidence of acute thromboembolic events,postoperative thrombocytopenia,bleeding risk were evaluated respectively in treating and control group of patients.Methods: We selected 117 patients who were hospitalized from May 1st to November 30 th in the cardiovascular CCU ward of Hainan Provincial People's Hospital,Nanhua University,as experimental subjects.Including 60 patients with acute myocardial infarction(AMI),57 patients with AMI and T2 DM patients in two subgroups,and confirmed by coronary angiography with thrombosis,consistent with PCI indications.Patients in two subgroups were randomized into treatment and control groups according to the order of admission and randomly divided into treatment group and control group.AMI treatment group(A group)was treated with coronary artery injection of tirofiban during PCI.In the AMI control group(B group),31 patients received normal saline injection during PCI.In the AMI and T2 DM treatment group(C group),29 patients underwent coronary artery tirofiban during PCI and AMI and T2 DM control group(D group)were 28 patients underwent normal saline injection during PCI.The above cases were accurately diagnosed according to the 2007 American Heart Association guidelines and the 2017 American Diabetes Association diagnostic criteria.All patients were excluded from the new stroke,severe liver,kidney,heart failure,blood system damage and trauma.In the two groups of patients,age,sex,past history and other routine data,p> 0.05,the difference was not statistically significant.All patients were given clopidogrel 300 mg daily before surgery.Tirofiban was administered to patients in group A and C during surgery,and saline control was administered to patients in group B and D.After long-term oral aspirin 100mg/d,clopidogrel75mg/d for one year,low molecular weight heparin 5000IU/12 h subcutaneous injection then lasting 3-5 days.Rosuvastatin,metoprolol,valsartan and other standard therapy for secondary prevention of coronary heart disease were administered.Venous blood was collected before and after PCI.All blood samples were centrifuged at 3,000 rpm for 15 minutes at room temperature.The plasma was separated and stored in a-80°C refrigerator for testing.The samples were then thawed at room temperature.The incidence of stent thrombosis was compared between the two groups of patients,and the thrombocytopenia and hemorrhage within 48 hours after administration were observed.Statistical analysis of all datauses SPSS version 20.0 software.Results:? Prior to treatment with tirofiban,the strongest PTS was observed in the AMI and T2 DM groups,which was significantly higher than that of the AMI only group(all p < 0.05 ? p < 0.01).The main manifestations were Tp P,v WF,GMP-140,and t-PA,ATIII.There was no significant difference in Plg between the groups of patients,and there was no statistical significance(p>0.05).?After treatment with tirofiban,the PTS in the treatment groups(groups A and C)of each subgroup was significantly improved.The PTS molecular markers Tp P,v WF,and GMP-140 were lower.The control group was significantly lower,t-PA,ATIII were significantly higher than the control group(B group,D group)of each subgroup,the difference was statistically significant(p<0.05 ? p<0.01),there was no significant difference before and after Plg treatment,no statistics Significance(p>0.05).?After treatment with tirofiban,the PTS indexes of group A and group C were significantly improved.The PTS molecular markers Tp P,v WF,and GMP-140 levels were significantly decreased,while t-PA,ATIII were significantly elevated(p<0.05),but there was no significant difference before and after Plg treatment(p>0.05).?Comparing the control group(B,D)with the treatment group(A,C),the postoperative thrombosis rate was significantly increased(6.779%,0%,p=0.044);?Observed the patient's use of drugs and withdrawal of thrombocytopeniaand bleeding 48 hours after treatment,the patients in the treatment group and the control group,the difference was not statistically significant;Conclusion: The PTS in patients with AMI and diabetes is more severe than that in non-diabetic patients with AMI.The efficacy of tirofiban in PCI for patients with AMI and diabetes is slightly worse than that for non-diabetic patients with AMI.It may be that patients with AMI and diabetes have heavier thrombus burden.In summary,Tirofiban treatment during PCI can interfere with PTS in patients to inhibit platelet activity,reduce thrombus burden,help increase arterial and epicardial blood flow in infarct-related arteries,protect cardiac function,and reduce postoperative thrombosis.The rate of formation does not significantly increase the risk of bleeding.