Effect of tirofiban plus clopidogrel and aspirin on primary percutaneous coronary intervention via transradial approach in patients with acute myocardial infarction

背景：阿司匹林和 clopidogrel 能改进心肌的灌注并且在经皮的冠的干预(一种总线标准) 期间减轻心肌的损害。静脉内的 tirofiban 的增加是否在这个过程期间生产进一步的利益，没在圣片断举起被澄清心肌的梗塞(STEMI ) 病人。我们在经由 transradial 动脉途径经历了主要一种总线标准(p 一种总线标准) 的 STEMI 病人上评估了这。方法：连续病人被使随机化进 tirofiban 组(n=72 ) 或安慰剂组(n=78 ) 。起始的包括的 Angiographic 分析和在心肌的梗塞(TIMI ) 的最后的血栓溶解流动等级(TFG ) ，改正的 TIMI 框架计数(CTFC ) 和血栓形成容器的心肌的灌注分级的 TIMI (TMPG ) 。血小板聚集率(同等) ，肌酸磷酸激酶(CPK ) ， CPK isoenzyme MB (CPK-MB ) 和我铺平的 troponin 被测量， TIMI 定义被用来估计流血复杂并发症。左室的表演参数与平衡放射性核种脑室造影术被调查。主要不利心脏的事件(向) 被跟随在上面为 6 个月。结果：TFG 0 的案例并且 1 在一种总线标准前， TFG 0 指南电线的十字路口什么时候首先是在一种总线标准以后的 TFG 3 的更少，和案例，比在安慰剂组的那些是在 tirofiban 组的更多。最后的 CTFC 是少数和发生不回流现象更低，也最后的 TFG 3 的百分比比在安慰剂组(所有 P【0.05 ) 的那些在 tirofiban 组是更高的。吝啬的山峰 CPK-MB 显著地更低，当时左室的性能参数在一种总线标准以后的 1 个星期更在安慰剂组比那些在 tirofiban 组被改进。同等显著地立即在 tirofiban 注入以后被减少。在 tirofiban 组的 6 月的向的发生在安慰剂组显然是比那低的。没有统计差别关于为复杂并发症放血在二个组之间被注意。结论：除了在有经由 transradial 动脉存取的 p 一种总线标准的 STEMI 病人的阿司匹林和 clopidogrel，静脉内的 tirofiban 注入能快速禁止血小板聚集，松开闭塞的血栓，改进心肌的灌注并且减少有容器存取的很少复杂并发症的向的发生并且流血。

Background Aspirin and clopidogrel can improve myocardial reperfusion and alleviate myocardial injury during percutaneous coronary intervention （PCI）. Whether the addition of intravenous tirofiban during this procedure produces further benefit has not been clarified in ST segment elevation myocardial infarction （STEMI） patients. We evaluated this on STEMI patients who underwent primary PCI （p-PCI） via transradial artery approach. Methods Consecutive patients were randomized into tirofiban group （n=-72） or placebo group （n=-78）. Angiographic analysis included initial and final thrombolysis in myocardial infarction （TIMI） flow grade （TFG）, corrected TIMI frame count （CTFC） and TIMI myocardial perfusion grade （TMPG） of the thrombotic vessel. Platelet aggregation rate （PAR）, creatine phosphokinase （CPK）, CPK isoenzyme MB （CPK-MB） and troponin I levels were measured and TIMI definitions were used to assess bleeding complications. Left ventricular performance parameters were investigated with equilibrium radionuclide ventriculography. Major adverse cardiac events （MACE） were followed up for 6 months. Results The cases of TFG 0 and 1 before PCI, TFG 0 when first crossing of guide wire were less, and the cases of TFG 3 after PCI was more in tirofiban group than those in placebo group. The final CTFC was fewer and the incidence of no reflow phenomenon was lower, as well the percentage of final TFG 3 was higher in tirofiban group than those in placebo group （all P 〈0.05）. Mean peak CPK-MB was significantly lower, while the left ventricular performance parameters 1 week after PCI were much more improved in tirofiban group than those in the placebo group. PAR was significantly decreased shortly after tirofiban infusion. The incidence of 6-month MACE in tirofiban group was obviously lower than that in the placebo group. No statistical difference was noted between the two groups with regard to bleeding complications. Conclusions Intravenous tirofiban infusion, in addition to aspirin and clopidogrel in STEMI patients with p-PCI via transradial artery access, can quickly inhibit platelet aggregation, loosen occlusive thrombus, improve myocardial reperfusion and reduce incidence of MACE with few complications of vessel access and bleeding.