| Background:ST-segment elevation myocardial infarction(STEMI)is mainly caused by acute coronary occlusion due to rupture of atherosclerotic plaque and thrombosis.GP Ⅱb/Ⅲa inhibitor(GPI)is a highly effective platelet aggregation inhibitor for STEMI with high thrombus burden and no-/slow reflow.The duration of GPI use after primary percutaneous coronary intervention(pPCI)in STEMI patients with high thrombus burden is controversial.There is limited evidence of the effectiveness of short-term GPI intravenous infusion in the targeted patients.Part ⅠAims:Efficacy of short-term and long-term GPI intravenous infusion on clinical prognosis in STEMI patients underwent pPCI.Methods:From July 2016 to January 2021,314 STEMI patients who underwent pPCI using GPI were enrolled.The patients were divided into two groups based on the tirofiban duration(<24 h and≥24 h),and the follow-up period reached to 3 months.The primary end point was the major adverse cardiovascular event(MACE)including cardiac death,nonfatal myocardial infarction,target vessel revascularization,and nonfatal stroke.And the safety end point was the bleeding that defined by thrombolysis in myocardial infarction bleeding.Survival analysis was used to compare the 3 months cumulative MACE-free survival between different tirofiban duration groups.Results:The median duration of tirofiban use were 12 hours and 24 hours,respectively.There was no difference in in-hospital MACE(4.00%vs.4.27%,p=0.905)and bleeding events(3.33%vs.1.83%,P=0.486)between the two groups.Survival analysis suggested similar MACE-free survival rates for 3 months after pPCI(Log-rank test:p=0.640).In the high-risk subgroup analysis,there was no significant difference in the 3-month incidence of total MACE between short-term and long-term tirofiban use in the high thrombus burden subgroup(6.61%vs.8.76%,p=0.520)and the no-/slow-reflow subgroup(9.68%vs.12.68%,p=0.586).In the high thrombus burden subgroup,long-term duration of tirofiban had a higher peak level of CK-MB(293.90[172.60-440.40]vs.220.85[136.05-370.50],p=0.025)and wider left ventricular end diastolic diameter(48.00[46.00-52.00]vs.47.00[44.00-49.00],p=0.006)than short-term duration group.However,the proportion of high peak level of brain natriuretic peptide/N-terminal pro brain natriuretic peptide(BNP/NT-ProBNP)of long-term duration group was lower than that of short-term duration group(27.52%vs.38.64%,p=0.047).Long-term tirofiban use was significantly associated with lower peak BNP/NT-ProBNP levels after multivariate adjustment.Conclusion:In STEMI patients undergoing pPCI,compared to longer-term tirofiban group,short-term group had no significant difference in the cardiovascular prognosis.Long-term tirofiban infusion improved cardiac function in acute phase in STEMI patients with high thrombus burden.Part ⅡAims:Efficacy of short-term and long-term GPI intravenous infusion on coronary microcirculation after STEMI underwent pPCI.Methods:A total of 57 STEMI patients who underwent pPCI from 2019 to 2021 were included.They received intravenous tirofiban treatment and postoperative myocardial perfusion ultrasonography examination.The patients were divided into two groups based on the tirofiban duration(≤ 12 h and>12h),and the myocardial contrast echocardiography was performed after pPCI.The primary end point was microvascular perfusion score index(MPSI),and the secondary end points were wall motion score index(WMSI)and left ventricular mass index(LVMI).Results:The median duration of tirofiban use was 11 hours and 22.75 hours,respectively.The results of criminal blood vessel-associated MPSI suggested that the two groups had similar microcirculation perfusion(1.00 vs.1.00,P=0.651).And criminal blood vessel-associated WMSI indicated that the two groups had similar ventricular wall motion(1.57 vs.1.50,P=0.634).The result of LVMI suggested that the degree of left ventricular remodeling was similar between the two groups(114.51 vs.115.24,P=0.245).Conclusion:In STEMI patients undergoing pPCI,the efficacy of short-term tirofiban infusion on coronary microcirculation was similar to long-term tirofiban infusion.General conclusion:For STEMI patients underwent pPCI:In terms of clinical prognosis,the efficacy of short-term and long-term tirofiban infusion was similar,but long-term tirofiban infusion could improve cardiac function in acute phase in those with high thrombus burden;As for coronary microcirculation,the small sample-size study suggested that short-term tirofiban infusion was as effective as long-term tirofiban infusion. |
PDF Full Text Request