Effects of tirofiban intracoronary artery during primary percutaneous coronary intervention in patients with caute myocardial infarction
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Objective To investigate the effect of glycoprotein Ⅱb/Ⅲa receptor blockade with tirofiban intracoronary artery injection on myocardial blush perfusion recovery and clinical outcome in patients with acute myocardial infarction(AMI) treated by primary percutaneous coronary intervention(PCI).Methods 178 patients with their first AMI under going PCI were randomized to tirofiban group and control group.TIMI grade,corrected TIMI frame count(CTFC),TMP of myocardial infuse,descended degree of ST-segment,level of NT-proBNP at the PCI time and 6 months after PCI,cardiac ejective fraction 1 week and 6 months after PCI,harmful event during 6 months were measured.Results There was no difference between two groups in percentage of TIMI 3 flow achieved in IRAs after PCI.Fewer TIMI frames and higher percentage of TMP grade 3 of IRAs were achieved in tirofiban group.There was higher ST segment resolution in the tirofiban group compared with control group after PCI.NT-proBNP were decreased significantly after PCI by one week and 6 months.Cardial ejective fraction was signifcantly higher in the tirofiban group than that in the control group by 6 months.There were significant difference between the two groups in occurrence of MACE in 6 months follow up(P0.05).Conclusions Application of tirofiban intracoronary artery during primary PCI in patients with AMI was safe and effective,which improves microvascular perfusion and clinical results.Keywords:
Tirofiban
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Objective:To evaluate the safety and efficacy of tirofiban,a specific inhibitor of the platelet glycoproteinⅡb/Ⅲa receptor,in the treatment of patients with acute myocardial infarction(AMI) undergoing emergency percutaneous coronary intervention(PCI).Method:A total of 106 AMI patients were randomly divided into tirofiban group(n=55,received tirofiban and emergency PCI therapy)and control group(n=51,only received emergency PCI therapy).The coronary reperfusion flow(TIMI grade) of infarct related artery(IRA) after PCI,the resolution of the sum of ST segment elevation(sumSTR) at 90 min after the procedure,the changes of cardiac enzyme at 6 h and 12 h afterwards,the left ventricular ejection fraction(LVEF) one week later,the major adverse cardiac events within 30 d,bleeding and thrombocytopenia complications were analyzed and compared between the two groups.Result:The two groups have the similar baseline clinical characteristics.Both the average TIMI reperfusion grades and the resolution of sumSTR at 90 min after PCI were increased while the MACE rates within 30 days after PCI decreased markedly in the tirofiban group compared to those in the control group(P0.05).There were no differences in CK-MB levels and LVEF between the two groups.Although the slight bleeding incidence in the tirofiban was less than those in the control group(16.17% vs 5.17%,P=0.126) no severe bleeding and thrombocytopenia was observed.Conclusion:The study showed that tirofiban could safely and effectively reduce the incidence of the ischemic events in the patients with AMI undergoing emergency PCI.
Tirofiban
TIMI
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Objective: To investigate the effect of glycoprotein IIb/IIIa receptor blockade tirofiban on microvascular flow and survival in patients with ST-segment elevated myocardial infarction (STEMI)after primary percutaneous coronary intervention(PCI). Methods: A total of 119 patients with STEMI underwent primary PCI which had angiographic evidence of initial total occlusion of infarct-related artery and finally restored to TIMI 3 flow after PCI were divided into the tirofiban group(n =51) and the control group (n =68). TMPG after PCI, the resolution of the sum of ST-segment elevation at 60 minutes after PCI , and cardiac function 1 week after PCI were assessed. The bleeding complications were also assessed. Results: (1)Baseline clinical and angiographic characteristics of the two groups were similar. (2) TIMI myocardial perfusion grade (TMPG) 0-1 grade rate after PCI was lower in tirofiban group(P0.05),3 grade rate after PCI was higher in tirofiban group(P0.05).(3)There were less frequently complete ST-segment resolution in tirofiban group than that in control group.(4)LVEF was higher in tirofiban group than that in control group (P0.05). (5)There were slightly more minor bleeding complications in the tirofiban group compared with the control, but had no difference in statistics. Conclusion: Tirofiban can ameliorate microvascular perfusion and cardiac function of patients with STEMI undergoing primary PCI.
Tirofiban
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Objective To investigate the coronary perfusion and heart function of glycoprotein Ⅱb/Ⅲa receptor blockade tirofiban in patients with ST-segment elevated myocardial infarction(STEMI) after primary percutaneous coronary intervention(PCI).Methods 100 patients with STEMI underwent primary PCI were divided into the tirofiban group(n=50) and the control group(n=50).Thrombolysis in myocardial infarction(TIMI) grades were evaluated,the resolution of elevated ST-segment after PCI and left ventricular ejection fraction(LVEF) were analyzed.Results ①TIMI grade 0～2 was lower in tirofiban group(10 cases vs.29 cases,P 0.05) and grade 3 was higher in the tirofiban group than the control group(40 cases vs.21 cases,P 0.05).②ST-segment resolution rate in the tirofiban group was higher than that in the control group.③LVEF was higher in the tirofiban group than that in the control group [(60±8)% vs.(53±10)%,P 0.05).Conclusions Tirofiban improves coronary perfusion and heart function in patients with STEMI after primary PCI.
Tirofiban
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AIM:To investigate the effect of glycoprotein IIb/IIIa receptor blockade with tirofiban on the clinical outcomes and myocardial blush perfusion recovery in acute myocardial infarction(AMI)patients treated by primary percutaneous coronary intervention(PCI).METHODS:Sixty AMI patients were randomized to receive either tirofiban plus primary PCI(group A,n=30)or primary PCI alone(group B,n=30).Baseline characteristics,results of primary PCI,cardiac function and the incidence of cardiac events were compared between the 2 groups.RESULTS:No significant difference was observed between the 2 groups in basic clinical or angiographic characteristics before PCI and in the percentage of TIMI 3 flow achieved in infarction related arteries(IRAs)after PCI(P0.05,respectively).Fewer TIMI frames [(23.5±7.6)frames vs(32.1±4.2)frames,P0.05] and higher percentage of blush grade 3 of IRAs(77.0% vs 33.0%,P0.01)were observed in tirofiban group.Follow-up data before hospital discharge showed lower peak serum CK levels [(28.4±5.0)μkat/L,(37.7±8.7)μkat/L,P0.05] and faster ST segment resolution in the tirofiban group after PCI [(69.8±14.2)% vs(38.6±11.7)%,P0.05].During hospital stay,no significant difference in LVEF and LVEDD was observed between the two groups(both,P0.05)but significant difference was found during follow-up period(both,P0.05).No significant difference in postoperative bleeding-related complications was found between the 2 groups(P0.05),but the main adverse cardiac events(MACE)between the 2 groups were significantly different(P0.05).CONCLUSION:Adjutant therapy with tirofiban is safe and effective for patients with acute myocardial infarction who undergo primary PCI.Tirofiban improves the clinical outcomes and myocardial blush perfusion after PCI.
Tirofiban
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Objective To assess the safety and efficacy of direct intra-coronary injection of tirofiban followed by transfusion via vein in patients with acute myocardial infarction(AMI) undergoing emergency percutaneous coronary intervention(PCI).Methods Between Dec 2008 and Dec 2010,74 patients with AMI were randomly assigned into tirofiban group and conventional PCI group,37 patients were given tirofiban intra coronary artery undergoing emergency PCI in tirofiban group,followed with continuous transfusion via vein,while the other 37 patients were treated by conventional PCI during the same period,who were only given tirofiban via vein undergoing emergency PCI.The basic clinic condition,TIMI thrombus score,TIMI flow grades,corrected TIMI frame count,TIMI myocardial perfusion and the resolution of the sum of ST-segment elevation(sumSTR) at 90 minutes after the procedure,recent cardiaovascular events,bleeding events before and after the procedure and left ventricular ejection fraction(EF) were compared between the two groups.Results No significant differences were shown in basic clinic condition,TIMI Ⅲ flow grades acquirtion,recent major cardiaovascular events and bleeding events between the two groups(P 0.05),but the former group acquire more TMP Grade 2 or 3 than the latter group(94.6% vs 67.6%,P = 0.003) and lower corrected TIMI frame count(91.9% vs 64.9%,P = 0.005),and patients received tirofiban from direct injection into coronary artery were more likely to achieve higher sumSTR(67.6% vs 27.0%,P = 0) and EF after one week [(56.62 ± 6.897) vs(51.59 ±6.817),P =0.002) ].Conclusion The study demonstrates that direct injection of tirofiban into crornary artery can be safe and efficient,which can improve the myocardial microcirculation reperfusion and patients’short-time prognosis,but long-time prognosis still needs more investigations.
Tirofiban
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Objective To evaluate the efficacy and safety of tirofiban intracoronary used in the patients with acute STelevation myocardial infarction(STEMI) in primary percutaneous coronary intervention(PCI).Methods Sixty-two patients with STEMI(both in the incidence of the 12-hour period) who were ready to receive primary PCI were randomly divided into three groups:control group(non-use of tirofiban,n=20),tirofiban IV group(intravenous tirofiban bolusonly,n=21) and tirofiban IV IC group(intravenous and intracoronary tirofiban bolusonly,n=21).The thrombolysis in myocardial infarction(TIMI) grade and corrected TIMI frame count(CTFC) were observed in PCI process.Peak serum CKMB levels,left ventricular ejection fraction(LVEF),hemorrhage event,thrombocytopenia and major adverse cardiovascular events(MACEs) were also evaluated while in hospital.Results Compared with control group,there were significant differences in the scores of CTFC,LVEF and CKMB in tirofiban IV IC group.However,there were no significant difference in the scores of TIMI grade,MACE in hospital,hemorrhage event and thrombocytopenia.Conclusion Application of tirofiban during primary PCI in STEMI patients is safe and effective.
Tirofiban
TIMI
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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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Objective:To explore the effect of intracoronary tirofiban on TIMI flow grade,creatine kinase MB(CK-MB),troponin T(TnT),major adverse cardiovascular events(MACE)in patients with ST-elevation myocardial infarction(STEMI)undergoing primary percutaneous coronary intervention(PCI).Method:All 164 patients with STEMI undergoing primary PCI were selected and randomized into intracoronary tirofiban group(n=84)and intravenous tirofiban group(n=80).TIMI flow grade on infarction related artery(IRA),CK-MB, and TnT were measured at baseline and after PCI.ST segment resolution was observed in 2hours after primary PCI.The incidence of bleeding complications was observed in 3days after primary PCI.The incidence of MACE was recorded at 30days after primary PCI.Result:Compared with intravenous tirofiban group,TIMI flow grade on IRA was significantly improved[(2.95±0.17)vs(2.84±0.22),P0.05],the levels of CK-MB and TnT in 12 hours and 24hours after PCI were significantly decreased(all P0.05),the incidence of ST segment resolution greater than 70%in 2hours after PCI was increased(P0.05)in intracoronary tirofiban group.The incidence of bleeding complications and MACE at 30days after primary PCI was showed no significant difference between 2 groups.Conclusion:In patients with STEMI undergoing primary PCI,intracoronary tirofiban may improve myocardial reperfusion and decrease infarction size more effectively compared with intravenous tirofiban.
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Objective To evaluate the influence of intracoronary tirofiban on the incidence of no reflow after percutaneous coronary intervention ( PCI ) in patients with acute ST segment elevation myocardial infarction ( STEMI ).Methods 120 STEMI patients were divided into tirofiban group ( tirofiban and direct PCI,n =60 ) and control group ( direct PCI,n =60 ).During PCI,coronary flow was evaluated according to TIMI flow grading and corrected TIMI frame count ( cTFC ).The changes in sum ST segment resolution ( sumSTR ) were compared one hour after PCI; myocardial perfusion defect score index ( CSI ) and wall motion score index ( WMSI ) were computed 24 hours after PCI according to myocardial contrast echocardiography ( MCE ).Results The blood flow of TIMI grade 3 was greater in tirofiban group than in the control group ( P ＜ 0.05 ) and cTFC was significantly lower in tirofiban group than in the control group ( P ＜ 0.01 ); CSI and WMSI were was significantly lower in tirofiban group than in the control group ( 1.23 + 0.33 vs.1.38 + 0.43,1.52 + 0.39 vs.1.70 ± 0.38; P＜ 0.05 );,the ratio of sumSTR ＞ 70％ was significantly higher in the tirofiban group than in the control group ( P ＜ 0.05 ).Conclusions Intracoronary tirofiban can improve myocardial blood flow in STEMI patients after PCI and can prevent the occurrence of no reflow.
Key words:
Myocardial infarction; Tirofiban; Percutaneous coronary intervention; No reflow
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Aim To investigate the effect of tirofiban on coronary flow and microcirculation in patients with ST segment elevation myocardial infarction(STEMI) treated by primary percutaneous coronary intervention(PCI).Methods 58 patients with primary STEMI who underwent primary PCI were randomized to receive either tirofiban and primary PCI(n= 30) or primary PCI alone(n= 28).Baseline characteristics of the two groups were compared.The patency rate of infarct-related artery(IRA) before intervention,the flow of thrombolysis in myocardial infarction(TIMI) before and after surgery,the resolution of ST segment,endothelial cell apoptosis,blood coagulation factor,the incidence of bleeding complications and acute ischemic events during hospitalization as well as the left ventricular ejection fraction(LVEF) measured by echocardiography before discharge were studided.Results A greater percentage of TIMI 1 flow was achieved in the tirofiban group(P 0.05).On the other hand,TIMI 0 flow was more commonly found in patients of the control group(P 0.01).There was no difference between the two groups in percentage of TIMI 2 and 3 flow achieved in IRA after PCI(P 0.05).The no-reflow phenomena,reperfusion arrhythmia,endothelial cell apoptosis,blood coagulation factor were less in the tirofiban group(P 0.05),and faster ST segment resolution in the tirofiban group after PCI(P 0.05).There was no significant difference between the two groups in occurrence of major adverse cardiovascular events(MACE) or bleeding in both groups.Conclusions Tirofiban treatment can improve the rates of recanalizationand and the TIMI flow to the acute myocardial infarction with PCI,the surgery can be done better.It can avoid more myocardial cell to die permanently,and improve microcirculation disfunction.
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