The effect of intravenous thrombolysis on TIMI flow of patients with acute myocardial infarction
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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.Keywords:
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Objective To compare the clinical efficacy of direct percutaneous coronary intervention(PCI)and intravenous urokinase thrombolysis on patients with acute myocardial infarction(AMI).Methods 174 patients with AMI who were treated in our hospital from December 2009 to December 2012 were assigned to the thrombolysis group(68 patients)and PCI group(106 patients).The infarction related artery(IRA)recanalization rate,mortality rate,the incidence rate of serious complications,average hospitalization time in two groups were compared.Results IRA recanalization rate of PCI group was significantly higher than that of the thrombolysis group,with statistical difference(P 0.05).Mortality rate of PCI group was significantly lower than that of the thrombolysis group,with statistical difference(P0.05).The incidence rate of serious complications in PCI group was significantly lower than that in the thrombolysis group,with statistical differ- ence(P 0.05).Average hospitalization time of PCI group was significantly shorter than that of the thrombolysis group, with statistical difference(P0.05).Conclusion Direct PCI has better efficacy on AMI than thrombolytic therapy.
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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.
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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.
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Objective: To evaluate the efficacy and safety of facilitated PCI (low-dose rt-PA combined with immediate planned rescue percutaneous coronary intervention) in ST-segment elevation acute myocardial infarction (STEMI). Methods: Two hundred and fifteen patients with STEMI were divided into direct PCI group (n=150) and facilitated PCI group (n=65). The patients in direct PCI group were under angiography without thrombolysis, while the patients in facilitated PCI group were under an intravenous drip of 50 mg rt-PA during 30 minutes before PCI. The patients with TIMI grade 0~2 or TIMI grade 3 but residual stenosis ≥70% (132 patients in direct PCI group, 52 patients in facilitated PCI group) were implanted with stents. The rates of recanalization before and after PCI, of the usage of stents,of ST-segment resolution, and the left ventricular ejection fraction (LVEF) and major hemorrhage and major adverse cardiac events (MACE) in hospital were compared in two groups. Results: Compared with direct PCI group, the rates of recanalization and TIMI grade 3 before angioplasty were significantly higher in facilitated PCI group(49.2% vs 20.0%, P=0.00; 27.7% vs 14.0%, P=0.02); the rate of TIMI grade 3, ST resolution after angioplasty and LVEF in facilitated PCI group were significantly higher [96.9% vs 88.0%, P=0.04; 92.3% vs 78.7%, P=0.01; (64.5±7.9)% vs (51.5±15.6)%; P0.05]. There were not significantly different for usage of stents, major hemorrhage and MACE in two groups. There was no intracerebral bleeding in two groups. Conclusion: Facilitated PCI, which can reduce the time of reperfusion-beginning and improve the rate of TIMI grade 3 and myocardial reperfusion and left ventricular function without increasing MACE and major hemorrhage, is effective and safe for the patients with STEMI without thrombolysis contraindication.
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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.
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Ambiguous data about comparability regarding clinical outcomes for prehospital thrombolysis, coupled with timely coronary angiography, and primary percutaneous coronary intervention (PCI) in the early after acute ST-segment elevation myocardial infarction (STEMI), there are now. In the STREAM trial 1892 patients with STEMI diagnosed within 3 hours after onset of symptoms, and whom it was impossible to perform primary PCI within 1 h after the first medical contact, were randomly assigned into two treatment groups: a) primary PCI b) prehospital thrombolytic therapy with bolus tenecteplase (dose decreased by half in patients aged ≥75 years) in combination with clopidogrel and enoxaparin followed by admission to the hospital, where it was possible to perform PCI. Emergency coronary angiography performed if thrombolysis failed. Coronary angiography and PCI of the infarct-related artery were performed in the period from 6 to 24 hours after randomization and thrombolytic therapy in the case of an effective thrombolysis. Primary endpoints include a composite of death, shock, congestive heart failure, or reinfarction up to 30 days. The primary endpoint occurred in 116 of 939 patients (12.4 %) of the thrombolysis group and in 135 of 943 patients (14.3%) of the primary PCI group (relative risk in the group thrombolysis 0.86, 95% confidence interval 0.68-1.09, p=0.21). Emergency angiography was required in 36.3% of patients in the thrombolysis, and the remaining patients, coronary angiography and PCI were performed at a mean of 17 hours after randomization and thrombolytic therapy. Thrombolysis group had more intracranial hemorrhages than primary PCI group (1.0% vs 0.2%, p=0.04; after correction protocol and dose reduction by half of tenecteplase in patients ≥75 years: 0.5% vs. 0.3%, p=0.45). The rate of non- intracranial bleeding in two treatment groups did not differ. Prehospital thrombolysis followed by coronary angiography and timely PCI provide effective reperfusion in patients in the early stages of STEMI that was not possible to carry out primary PCI within 1 h after the first medical contact. Nevertheless, fibrinolysis was associated with a slight increase in the risk of intracranial bleeding.
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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 study TIMI(thrombolysis in myocardial infarction) flow influence of GPⅡb/Ⅲa receptor antagonists(tirofiban) in patients with acute STEMI before primary PCI.Methods The thirty-six STEMI patients(meanage 46.2±8.6 years old) admitted during Sept,2008 to July,2010 were included in the study.The patients were divided into the primary PCI group(n=17) and primary PCI plus tirofiban group(n=19).Changes in TIMI flow were observed during the operation.Results The incidence of slow flow and no reflow of tirofiban+PCI group was lower than that of the primary PCIgroup(3.75% vs 18.12%,P0.05);and embolism of distal IRA was all lower than that of the primary PCI group during operation(0% vs 15.78%,P0.05).Conclusion Tirofiban injection before primary PCI in patients with STEMI is feasible and can reduce the rate of no reflow during operation.
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ObjectiveTo evaluate the effects of tirofiban on no-reflow phenomenon in patients with acute myocardial infarction (AMI) receiving emergency percutaneous coronary intervention (PCI). MethodsFrom January 2006 to December 2008,104 AMI patients were divided into tirofiban treatment and control groups (n=48 and 56,respectively) according to whether tirofiban was applied during emergency PCI. The patients' basic clinical characteristics,angiographic results,and PCI efficiency were compared between two groups. Thrombolysis in Myocardial Infarction study (TIMI) grading and TIMI frame count (TFC) were performed in all culprit vessels after emergency PCI. ResultsThere was no significant difference between two groups in basic clinical characteristics and preoperative angiogram. Compared with control group,better TIMI 3 blood flow (91.7 % vs 76.8 %,P = 0.0408),less no-reflow rate (4.2% vs 16.1 %,P=0.0491),less distal embolization rate (8.3 % vs.23.2 %,P =0.0408) and better TFC (20.2±2.8 vs 31.2±4.4,P=0.0225) were achieved in tirofiban treatment group. No severe bleeding complication occurred in any patients. Major adverse cardiac events were significantly higher in control group than in tirofiban treatment group (12.5% vs 8.9%,P=0.011). ConclusionTirofiban used during emergency PCI in patients with AMI can effectively prevent no-reflow phenomenon.
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