| Objectives:To investigate the difference and possible mechanism between intravenous tirofiban and intravascular tirofiban for myocardial tissue perfusion in STEMI patients undergoing emergency PCI with a heavy thrombotic load.Methods:A total of 79 STEMI patients who received emergency PCI in our hospital from October 2017 to April 2018 and had heavy thrombosis load were enrolled.On the basis of thrombus aspiration,they were randomly divided into the perivenous tirofiban group(group A,39 cases)and the coronary intervenous tirofiban group(group B,40 cases).In group A,10 g/kg of tirofiban was first injected intravenously,and in group B,10 g/kg of tirofiban was first injected via A suction catheter,followed by A maintenance dose of 0.15g/(kg · min)for 24-48 h in both groups.Observed two groups of preoperative and postoperative myocardial infarction thrombolysis therapy clinical trial(TIMI)flow grade,HST 2 period of fall,10 days after cardiac color doppler ultrasonic detection of left heart function and application Sonoclot testing platelet function,platelet function,PF),preoperative and postoperative 12 h enzyme-linked immunosorbent assay(ELISA)method in the detection of serum soluble CD40L(s CD40L)and matrix metalloproteinase 9(MMP-9),the incidence of major adverse cardiac events(MACE)during hospitalization.Results:Baseline data of the two groups of patients showed that there were no statistically significant differences in gender,age,complications(hypertension,diabetes,hyperlipidemia),time of onset,number of diseased vessels,number of stents implanted,etc.(P>0.05).Clinical data showed that intravascular tirofiban had a higher postoperative ST segment decline rate of 50% than intravenous tirofiban at 2h after surgery(67.5% vs.35.9%,P=0.019).The proportion of grade 3 blood flow in the clinical trial of thrombolytictherapy for myocardial infarction immediately after surgery(TIMI)was also higher(87.5%vs.64.1%,P=0.015).Group B patients after 12 h s CD40 Land MMP-9,10 days after application PF Sonoclot monitoring values were lower than group A(P < 0.05),and two groups of postoperative 12 h s CD40 L and MMP-9 are reduced compared with preoperative,10 days after application of color doppler ultrasound to monitor heart of Left heart ejection fraction,Left ventricular ejection fraction,LVEF),group B compared with group A is increased,However,there was no significant difference(P=0.185).There was no significant difference in major adverse cardiovascular events(MACE)during hospitalization(P=0.506).Correlation analysis showed that SCD40 L was significantly correlated with MMP9,SCD40 L and PF(r=0.697,p<0.001).R = 0.492,p < 0.001).Conclusions:(1)for STEMI patients receiving emergency PCI with heavy thrombosis load,intracoronal injection of tirofiban after thrombus aspiration can achieve a higher level of tissue perfusion than intravenous administration without increasing the risk of massive bleeding,which may be related to the inhibition of inflammatory factors.(2)mmp-9 may play a role through the cd40-cd40 l pathway,inhibiting inflammatory factors and assisting in reducing platelet activation level.(3)for STEMI patients receiving emergency PCI with heavy thrombotic load,intra-coronary injection of tirofiban is a safe and effective treatment. |
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