Effect Of Thrombus Aspiration Combined With Low-dose Tirofiban On Myocardial Reperfusion And Safety In Elderly Patients With Acute ST-segment Elevation Myocardial Infarction

BACKGROUND With the rapid development of China’s social economy in recent years,the living standards of the people have been greatly enriched and improved.Problems such as poor lifestyles,dietary habits,and aging of the population have led to an increase in the prevalence of cardiovascular disease in China.Coronary atherosclerotic heart disease(CHD)has become the primary threat to national health.With the gradual promotion of direct percutaneous coronary interventions(PCI),the mortality of patients with acute ST-segment elevation myocardial infarction(STEMI)has been significantly reduced,but no reflow or slow blood flow events after infarction are still high,especially in elderly patients.One of the important reasons is the microcirculation disorder.Theoretically,the simultaneous use of both thrombus aspiration and tirofiban in PCI has synergistic effects.However,there are few relevant researches in clinical practice,and some studies have reached contradictory conclusions.The purpose of this study was to evaluate the effects of thrombus aspiration combined with low-dose tirofiban injection on myocardial reperfusion and safety in elderly patients with high thromboembolic acute STEMI after direct percutaneous coronary intervention.The purpose of this study was to evaluate the effect of thrombus aspiration combined with low dose tirofiban on myocardial reperfusion level and safety in elderly patients with high thrombus burden and acute ST-segment elevation myocardial infarction.METHODS A total of 127 elderly patients with STEMI with high thrombus burden who underwent PCI at Maanshan Clinical College from January 2014 to January 2019were randomly divided into observation group(62 cases)and control group(65 cases).The observation group was treated with thrombus aspiration combined with low-dose tirofiban injection in coronary artery before conventional PCI,while the control group was treated with conventional PCI.Postoperative clinical effects and complications were compared between the two groups.RESULTS In the postoperative observation group,the blood flow of the infarct-related artery was grade 3,the ST segment of the electrocardiogram was decrea sed by 50%and the LVEF was significantly higher than that of the control group[TIMI blood flow level 3:57 cases(91.9%)vs.49 cases(75.4%),χ~2=2.295,P=0.040;ECG ST segment fall>50%:50 cases(80.6%)vs.40 cases(61.5%),χ~2=5.611,P=0.018;LVEF value:(52.7±3.5)%vs.(50.9±5.0)%,t=2.229,P=0.028];CK-MB peak,fragmented QRS wave and pericardial effusion were lower in the observat ion group than in the control group[CK-MB peak:(274.4±173.1)U/L vs.(334.5±154.0)U/L,t=2.069,P=0.041;QRS wave:24 cases(38.7%)vs.38 cases(55.5%),χ2=4.955,P=0.026;pericardial effusion:6 cases(9.5%)vs.15 cases(23.1%),χ~2=4.128,P=0.042];30 days after operation,the observation group had fewer minor bleed eve nts than the control group[minor bleeding events:7 cases(11.3%)vs.4 cases(6.2%),χ~2=4.019,P=0.043],there was no significant difference between the two groups in the major bleeding and stroke events(P>0.05);6 months after the operation,There was no significant difference between the two groups in the MACE event(P>0.05).CONCLUSION Thrombus aspiration combined with intracoronary injection of low-dose Tirofiban can improve myocardial reperfusion in elderly patients with high thrombus burden STEMI without increasing the risk of severe bleeding.Therefore,it has a high clinical application value.