ABSTRACT
ObjectiveTo evaluate the safety and efficacy of tirofiba in the treatment of patients with acute ST-elevation myocardial infarction (STEMI) undergoing emergency percutaneous coronary intervention (PCI). MethodsA total of 158 patients with acute STEMI were randomly divided into tirofiban group 1 (59 cases, received tirofiban before PCI), tirofiban group 2 (56 cases, received tirofiban when PCI) and control group(43 cases, only received PCI). The coronary reperfusion flow(TIMI grade) of infarct related artery (IRA) after PCI, the resolution of the sum of ST segment elevation(sum STR) at 90 min after the procedure, the changes of myocardial enzyme at 6 h and 12 h afterwards, the left ventricular ejection fraction (LVEF) 1 week later, the major adverse cardiac events(MACE) within 30 d, bleeding and thrombocytopenia complications were analyzed and compared among the three groups. ResultsTIMI reperfusion grades in tirofiban group 1[98.3％(58/59 )]and tirofiban group 2[92.9％(52/56)]were higher than those in control group[60.5％(26/43)](P ＜0.05). The resolution of sum STR at 90 min after PCI in tirofiban group 1 [(89.3 ± 6.9)％]and tirofiban group 2[(82.4 + 7.3)％]was higher than that in control group[(65.6 +8.1 )％](P＜ 0.01 ),and there was significant difference between tirofiban group I and tirofiban group 2 (P＜0.05 ). The occurrence of MACE within 30 d was lower in tirofiban group 1 and tirofiban group 2 than that in control group (P＜ 0.05). The level of CK-MB at 6 h and 12 h afterwards was lower in tirofiban group 1 than that in tirofiban group 2,and tirofiban group 2 was lower than control group (P＜ 0.05). LVEF 1 week later in tirofiban group 1[(56.2 + 6.4)％]was higher than that in tirofiban group 2[(51.1 + 4.9)％]and control group[(49.8 + 5.7)％](P ＜ 0.05),but there was no significant difference between tirofiban group 2 and control group (P ＞ 0.05). Although bleeding incidence in tirofiban group 1 and tirofiban group 2 was higher than that in control group, no severe bleeding and thrombocytopenia was observed. Conclusion Tirofiban can safely and effectively reduce the incidence of the ischemic events in the patients with acute STEM1 during preoperative of emergency PCI.
ABSTRACT
s To compare the clinical effects of intravenously and orally administered aspirin in the treatment for acute coronary syndrome (ACS),and to evaluate the adverse effects of intravenous administration of aspirin.Methods One hundred and twenty-five patients with unstable angina pectoris or acute myocardial infarction were randomized into three groups:group 1 received intravenous aspirin (300mg/d,n =40),while groups 2 (n =42) and 3 (n =43) received orally administered aspirin (100mg/d and 300mg/ d,respectively).The control group included 30 patients with no heart disease or blood disease,and they had never taken aspirin and clopidogrel.Blood samples were taken at 2nd and 7th day of hospitalization.Platelet aggregation and the level ofplatelet activation marker CD62p were measured and compared among the groups.Patients were followed up for 6 months for the occurrence of major adverse cardiovascular events.Results There were no statistically significant differences in the decrease in adenosine diphosphate (ADP)-induced platelet aggregation rate (12.01±10.45%,6.76±14.62% and 9.73±16.72% for group 1,group2 and group 3,respectively),the decrease in arachidonic acid (AA)-induced platelet aggregation rate (6.73±11.34%,6.95±12.45% and 7.57±13.11%,respectively),and the decrease in CD62p level (10.89±18.62%,8.92±11.57% and 7.05±15.67%,respectively).At six months,there were 4 deaths (10%) in group 1,4 deaths (9.5%) in group 2 and 5 deaths (11.6%) in group 3 (P＞0.05).Conclusions Intravenous administration of aspirin provides a new approach as an anti-platelet treatment for ACS patients,especially those who can not tolerate oral administration of aspirin.(J Geriatr Cardiol 2008;5:212-216)