e0485 Clinic study of domestic tirofiban on TIMI Flow during facilitated PCI
Guo Lai-jingDayi HuHwan Seok YongTian QiangHuiying ZhangLiying XingZhi WangQU Hua-qingShi ZhentaoZhenzhong ZhangYoung-Rok DoQunzhong TangXuezhi ChenLin Xiumin
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Abstract:
Objective
To assess Thrombolysis In Myocardial Infarction (TIMI) flow of the nation-produced tirofiban in patients with ST-segment elevation myocardial infarction (STEMI) during primary Percutaneous Coronary Intervention (PCI).Methods
120 patients with STEMI during primary PCI from Nov 2006 to June 2009 were divided into two groups, tirofiban+PCI group of 60 cases (51 males and 9 females) with mean age (60.11±10.96) years old, and the other primary PCI group of 60 cases (42 males and 18 females) with mean age (64.33±11.91) years. The TIMI flow before and after operation were observed in all cases angiographically.Results
By using tirofiban before operation improved TIMI flow, a greater percentage of TIMI 1 grade flow was achieved in the tirofiban+PCI group compared with the primary PCI group before operation (13.3.8% vs 3.3%, p>0.05). There was no difference of TIMI 3 grade flow between the two groups after operation, TIMI 2 grade flow was lesser in tirofiban+PCI group (6.7% vs 3.4%, p>0.05).Reperfusion arrhythmia was lesser in tirofiban+PCI group (3.4% vs 6.7%).Conclusion
Tirofiban may improve TIMI flow of the IRA in patients with STEMI during emergency PCI.Keywords:
TIMI
Tirofiban
Objective
To assess Thrombolysis In Myocardial Infarction (TIMI) flow of the nation-produced tirofiban in patients with ST-segment elevation myocardial infarction (STEMI) during primary Percutaneous Coronary Intervention (PCI).Methods
120 patients with STEMI during primary PCI from Nov 2006 to June 2009 were divided into two groups, tirofiban+PCI group of 60 cases (51 males and 9 females) with mean age (60.11±10.96) years old, and the other primary PCI group of 60 cases (42 males and 18 females) with mean age (64.33±11.91) years. The TIMI flow before and after operation were observed in all cases angiographically.Results
By using tirofiban before operation improved TIMI flow, a greater percentage of TIMI 1 grade flow was achieved in the tirofiban+PCI group compared with the primary PCI group before operation (13.3.8% vs 3.3%, p>0.05). There was no difference of TIMI 3 grade flow between the two groups after operation, TIMI 2 grade flow was lesser in tirofiban+PCI group (6.7% vs 3.4%, p>0.05).Reperfusion arrhythmia was lesser in tirofiban+PCI group (3.4% vs 6.7%).Conclusion
Tirofiban may improve TIMI flow of the IRA in patients with STEMI during emergency PCI.TIMI
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Objective To eveluate the effect of tirofiban on TIMI flow in patients with STEMI during primary PCI. Methods Forty-eight patients with STEMI who underwent primary PCI were randomly divided into two groups which were: the tirofiban+PCI group (n=27) and the primary PCI group (n=21). The TIMI flow before and after the operation were reviewed angiographically. Results A greater percentage of TIMI 1 flow was archieved in the triofiban+PCI group compared with the primary PCI group before operation (37% vs 9.5%, P0.05). On the other hand, TIMI 0 flow was more commonly found in patients in the primary PCI group compared with the tirofiban+PCI group (38.1% vs 7.4%, P0.01). There was no difference in the archievement of TIMI 3 flow between the two groups after operation, but the occurance of TIMI 2 flow was less in the tirofiban+PCI group compared with the primary PCI group. Conclusion Tirofiban may improve TIMI flow of the IRA in patients with STEMI during primary PCI.
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Background Thrombolysis with streptokinase (STK) is the most widely used reperfusion strategy for ST elevation myocardial infarction (STEMI) in India. Achieving full reperfusion as evidenced by thrombolysis in myocardial infarction (TIMI) flow grade 3 in coronary angiography (CAG) is associated with better outcomes. Recent studies show that hematological indices like neutrophil-lymphocyte ratio (NLR) and mean platelet volume (MPV) estimated before thrombolysis could predict TIMI 3 flow. We studied clinical, electrocardiographic and hematological parameters associated with TIMI 3 flow after thrombolysis with STK. Methods We prospectively studied 201 adult patients with STEMI presenting within 12 hours of onset of chest pain. Before thrombolysis, blood sample was collected for estimating NLR and MPV. Timing of CAG after thrombolysis was decided by consultant cardiologists. Patients were followed up for one month after discharge. Results Of 201 patients, 162 (81%) had relief of chest pain and 131 (65%) had ST segment recovery of ≥50% at 90 minutes after thrombolysis. CAG was performed within median (IQR) of four (3-5) days after thrombolysis. TIMI 3 flow was observed in 112 (56%) patients. NLR and MPV had no significant association with TIMI 3 flow. In multivariable analysis, ST-segment recovery of ≥50% at 90 minutes was associated with TIMI 3 flow (adjusted OR 3.47, 95% CI: 1.84-6.53, P = <0.001). Of 198 patients followed up for one month after discharge, 13 (6.5%) died. Conclusions In patients with STEMI, ST-segment recovery of ≥50% at 90 minutes after thrombolysis with STK predicted TIMI 3 flow independently. NLR and MPV values were not predictive of TIMI 3 flow.
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To study the efficacy and safety of tirofiban in patients with acute non-ST- segment elevation myocardial infarction (NSTEMI) without early reperfusion intervention.A total of 151 NSTEMI patients without early reperfusion intervention were enrolled in the study and randomized to the tirofiban group (n = 76) and the control group(n = 75). Coronary angiography was performed at day 3 and day 7, while percutaneous coronary intervention (PCI) was performed when necessary. Parameters including thrombolysis in myocardial infarction (TIMI) flow, bleeding complications and clinic events within 30 days were compared between the two groups.Before PCI, no increase in the percentage of patient with TIMI flow better than TIMI-2 was observed by the treatment of tirofiban (69.3% vs 78.9%, P = 0.10). While after PCI, significant increase in the percentage of patient with TIMI flow better than TIMI-2 was manifested in the tirofiban group (96.0% vs 100.0%, P = 0.04). Tirofiban treatment also significantly decreased the rate of poor myocardial perfusion after PCI (19.7% vs 34.7%, P = 0.04). There were 0 and 4 major adverse cardiovascular events (MACE) within 30 days observed in the tirofiban group and the control group (0.0% vs 5.3%, P = 0.05). No difference between the two groups was found in the bleeding complications within 30 days including the mild hemorrhage (5 vs 4 cases, P = 0.75), severe hemorrhage (2 vs 1 cases, P = 0.56) or severe thrombocytopenia (2 vs 0 cases, P = 0.49).Tirofiban treatment does not increase the bleeding complications in NSTEMI patients without early PCI. Tirofiban can improve the TIMI flow and the myocardial perfusion after PCI with less MACE within 30 days.
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Objective To evaluate the effect of Tirofiban on primary emergency percutaneous coronary intervention(PCI) result in patients with acute myocardial infarction(AMI).Methods Sixty AMI patients on admission in emergency room were divided into two groups: early group(receive Tirofiban on admission) and late group(receive Tirofiban after angiography).TIMI grade,TIMI myocardial perfusion grade(TMPG),platelet aggregation rate and bleeding in both groups were observed and compared before and after PCI.Adverse cardiovascular events were also recorded in hospital and during 3 months' follow-up.Results Before PCI,TIMI 3 flow rate was significantly higher in early group than in late group.However,TIMI 3 flow rate after PCI was not significantly different between early group and late group.TMPG 2～3 rate was higher in early group than in late group,whether compared before PCI or after PCI.Platelet aggregation rate after PCI was lower than before PCI in both groups,there was no difference between groups.Conclusions Early use of Tirofiban could significantly improve forward blood flow in target vessels.It is effective and safe in AMI patients treated with primary PCI.
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목적: 우리나라에서 허혈성 심장 질환의 유병률이 높아지고 있으며, 관상동맥 중재술(percutaneous coronary intervention, PCI)이 중요한 치료 방법의 하나로서 시행되고 있다. 본 연구를 통하여 최근 10년간 PCI를 시행받은 65세 이상의 고령 환자들의 임상양상의 변화를 확인하였다. 방법: 1999년 6월부터 2009년 6월까지 PCI를 시행받은 65세 이상의 3,209명[남성:여성 1950명(71.4±5.21세):1,359명(72.5±5.47세)]의 환자를 대상으로 하여 기간에 따라 4개의 군으로 나누었다. 네 군 간의 임상적 특징, 성별 간의 차이, 관상동맥 조영술 및 PCI 소견의 차이, 시술 후 1년 이내 주요 심장 사고의 발생을 분석, 비교하였다. 결과: 지난 10년간 PCI를 시술 받은 고령 환자의 성비는 지속적으로 남성의 비율이 높았다[남성(60.8%):여성(39.2%)]. 평균 연령은 지속적으로 증가하였으며, 위험인자의 경우 고혈압의 유병률은 증가하였으며(p=0.028), 흡연은 감소하였다 (p=0.002). 1년 이내 주요 심장 사고의 발생률은 지속적으로 감소하였으며(p=0.014), 남성은 여성보다 높은 생존율을 보였다(p=0.001). PCI 후 1년 이내의 주요 심장 사고는 105명(3.27%)에서 발생하였다. 주요 심장 사고의 발생 예측인자로는 여성(p=0.001), 75세 이상의 고령(p=0.008), 고혈압(p=0.049), 당뇨병(p=0.004), 흡연(p=0.009), 시술 후 낮은 TIMI flow (p=0.048) 등이었다. 결론: PCI를 시술 받은 고령 환자의 평균 연령은 지속적으로 증가하였으며, 고혈압은 지속적으로 상승하였고, 흡연은 감소하였다. 1년 이내 주요 심장 사고의 발생과 관련된 유의한 인자들은 여성, 고령, 고혈압, 당뇨병, 흡연, 시술 후 낮은 TIMI flow 등이었다.
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AIM To evaluate the effect of Tirofiban on TIMI flow in patients with acute coronary syndrome(ACS).METHODS Fifty-seven patients with ACS who would have selective coronary angiography(SCA)were randomly divided into two groups:Tirofiban+SCA group(n=29)and the SCA group(n=28),and TIMI flow was examined angiographically.RESULTS A greater percentage of TIMI ≥1 flow was achieved in Triofiban+SCA group compared with that in SCA group(97% vs 64%,P0.05).The percentage of TIMI 0 flow was significantly higher in SCA group compared with that in Tirofiban+SCA group(36% vs 3%,P0.01).CONCLUSION Tirofiban improves TIMI flow of IRA in patients with ACS.
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Objective:To assess the clinical effect and safety of intracoronary use of tirofiban in elderly patients with acute coronary syndrome(ACS) treated with percutaneous coronary intervention(PCI).Methods:A total of 102 ACS patients were divided into tirofiban group(n=52) and normal group(n=50) according to whether intracoronary using tirofiban,compared with each other for TIMI grade,corrected TIMI frame count(CTFC) and myocardial blush grade of related vascular after PCI operation, observed major advance cardiac effect and bleeding case.Results:There was more percentage of TIMI 3 flow achieved in tirofiban group after PCI (94.2%∶76.0%,P0.05).Fewer TIMI frames(21.9±8.7) frames∶ (30.8±3.6) frames,P0.05; and higher percentage of blush grade 3 of related vascular(75.0%∶32.0%,P0.01) achieved in tirofiban group.There was no significant difference between the two groups in occurrence of MACE or bleeding in both groups (P0.05).Conclusion:Intracoronary using of tirofiban during PCI in the elderly patients with ACS was safe and effective, which improves microvascular perfusion.
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Objective To observe the effect of intravenous thrombolysis on TIMI flow of acute myocardial infarction(AMI).Methods A total of 229 patients with AMI analysed retrospectively were divided into two groups:intravenous thrombolysis(IVT)group(n=131)and primary percutaneous coronary intervention(PCI)group(n=98).The treatment time and acute-phase outcomes were compared between the IVT group and the PCI group;104 patients in the IVT group received rescued or delayed PCI(IVT+PCI);TIMI flow was analysed between the IVT+PCI group and the PCI group.Results The time from the emergency room door to initiation of treatment was shorter in the IVT group than in the PCI group(67.79 min vs 134.54 min,P=0.000).At the initial coronary angiography,TIMI 3 flow and TIMI 2+3 flow were higher in the IVT+PCI group than in the PCI group(40.4% vs 24.5%,P=0.016;63.5% vs 36.7%,P=0.000 respectively).There was no significant difference between the IVT group and the PCI group in terms of major adverse cardiac events(MACE).Conclusion IVT as an initial treatment for AMI might achieve earlier reperfusion at TIMI≥2 flow,and it should be popularized in the primary hospitals.
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Objective To compare the effect of time choice on Slow-flow No-reflow(SNR) phenomena in patients with acute myocardial infarction(AMI) who underwent percutaneous coronary intervension(PCI).Methods 272 patients receiving PCI were enrolled.According to TIMI flow,the patients were divided into 2 study populations,who were divided into 3 groups according to immediate PCI or elective PCI,respectively.Results Patients receiving PCI from 24h to one week had more incidence of SNR according to 2 study populations(22/28 vs 8/60,22/28 vs 16/48 P0.05)(14/31 vs 6/62,14/31 vs 4/43,P0.05).Furthermore,patients of immediate PCI had less SNR incidence than those receiving PCI from one week to one month according to TIMI grade 2(8/60 vs 16/48,P0.05).Achievement of TIMI flow grade 3 according to TIMI grade 3 had no significant difference in patients receiving PCI from 24h to one week and those immediate PCI(6/62 vs 4/43,P0.05).Patients receiving PCI from 24h to one week had higher mortality of SNR in TIMI grade 2 group,compared with TIMI grade 3 group(22/28 vs 14/31,P0.05).Conclusion Patients with AMI who underwent immediate PCI had less SNR incidence than those of patients who received elective PCI.
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