The prognostic value of Tirofiban in patients with acute myocardial infarction after primary percutaneous coronary intervention
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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.Keywords:
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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.
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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.
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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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To evaluate the clinical outcomes of high-dose tirofiban in patients with ST-elevation myocardial infarction (ASTEMI) undergoing primary percutaneous coronary intervention (PCI).A total of 104 consecutive ASTEMI patients undergoing primary PCI were enrolled from January 2010 to February 2011. They were randomized into the high-dose tirofiban group (n = 52) and the normal-dose tirofiban group (n = 52). We measured the sumST-segment resolution of ECG post-PCI respectively and left ventricular ejective fraction (LVEF) at Day 90 post-PCI.After PCI, the sumST-segment resolution of ECG of the high-dose tirofiban group significantly improved than that of the normal-dose tirofiban group (38% ± 12% vs 34% ± 13%, P < 0.05). Before PCI, LVEF of two groups is 50.2% ± 1.4% vs 49.6% ± 1.1% (P > 0.05), but at day 90 post-PCI, LVEF had significant difference between two groups (60.1% ± 1.1% vs 56.0% ± 1.2%, P < 0.05). The rates of major and moderate hemorrhage did not differ significantly between two groups.High-dose tirofiban improves myocardial reperfusion and clinical outcome. It re-emphasizes the importance of further platelet aggregation inhibition in ASTEMI patients undergoing primary PCI.
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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 the therapeutic effects and safety of tirofiban on acute ST-elevation myocardial infarction(STEMI)patients undergoing PCI.Methods 80 patients with STEMI were randomized to receive tirofiban(n=40)or no(t n=40).TIMI flow,percentage of ECG-ST(sumSTR),Reperfusion arrhythmia,left ventricular ejection fraction(LVEF)and bleeding status were measured during PCI or 7days post-PCI.Results Baseline characteristics of patients between tirofiban and control groups were similar(P0.05).During PCI,TIMI 3 flow was high in tirofiban group compared to control group(38 VS 30,P0.05).SumSTR was high in tirofiban group compared to control group(15 VS 7,P0.05).However,no significant changes were found in bleeding in both two groups for 7 days post-PCI.Conclusion Tirofiban was shown to be a beneficial on TIMI 3 flow and sumSTR.Tirofiban do not increase the incidence of bleeding in patients with STEMI undergoing PCI.
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Objective To evaluate the efficacy of adjunctive use of tirofiban before percutaneous coronary intervention(PCI) in patients with acute ST elevated myocardial infarction(STEMI) through retrospective study.Methods 80 patients with acute STEMI receiving acute PCI and tirofiban were enrolled and divided into group A and group B according to when tirofiban was used.Patients in group A use tirofiban before PCI,while that in group B use tirofiban during or after PCI.The rate of TIMI grade 3 flow in the infarction related artery(IRA),major cardiovas-cular events and bleeding risks were compared between the two groups.Results In group A,the rate of TIMI grade 3 flow in the IRA was statistically higher compared with that of group B(25% vs 6.3%,P=0.040).Heart failure(HF) in 30 days was statistically lower(12.5% vs 33.3%,P=0.035).Bleeding risks showed no statistically significant differ-ence.Conclusion The use of Tirofiban before acute PCI in patients with acute STEMI in early stage might improve myocardial perfusion and decrease ardiovascular events such as HF.
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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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