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ObjectiveTo study the cardioprotective effects of ischemic post-conditioning on elderly patients with ST-elevation acute myocardial infarction (STEM1).MethodsConsecutive 215 patients with STEMI undergoing emergency percutaneous coronary intervention(PCI) were randomly assignedto receive ischemicpost-conditioningorconventional PCItreatment.The ischemic postconditioning (n=38) were conducted by 3 episodes of 30-second occlusion followed by 30-second reperfusion, while the control group (n= 46) was without any intervention after PCI.Reperfusion arrhythmias, corrected TIMI frame count (cTFC) and TIMI myocardial perfusion grade (TMPG)were compared between the two groups, respectively.Results The incidence of reperfusion arrythmias was less frequent in ischemic postconditioning group (21.1％ ,8/38) than in control group (45.7％ ,21/46) after PCI (x2 = 5.571, P＜0.05). The TIMI grade 3 flow was similar between two groups [(94.7％(36/38) vs. 82.6％( 38/46), x2= 2.919, P＞0.05], the cTFC levels (23.6±3.7vs. 26.1 ±5.9) and TMPG 3 perfusion [ 89.5％ (34/38) vs.69.6％ (32/46)] were significantly different (t= 5.434, P＜0.05; x2 = 4.899, P＜0.05, respectively) between two groups.ConclusionsIschemic postconditioning may reduce myocardial reperfusion injury in elderly patients with STEMI undergoing emergent PCI.
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Objective To explore the curative effect of tirofiban treatment on high-risk acute coronary syndromes (ACS) in elderly patients receiving an early percutaneous coronary intervention (PCI) treatment. Methods The 162 elderly cases including unstable angina pectoris and non-ST -segment elevation myocardial infarction (NSTEMI) undergoing early PCI were enrolled in this study.And they were assigned to early treatment group (n=82) and deferred selective group (n=80)according to the time of using tirofiban (Gp Ⅱ b/Ⅲ a inhibitor) treatment. The effectiveness of either strategic option on tissue-level perfusion was evaluated using the TIMI myocardial perfusion grade (TMPG) before and immediately after PCI. The corrected TIMI frame count (cTFC) was also used to assess coronary artery flow and myocardial perfusion. Bleeding complications and the composite end point events at 30 days were also evaluated. Results Of all the 162 patients, the TMPG 0-1 perfusion was observed in 65 patients (40.1%). The TMPG 0-1 perfusion was significantly less frequent in early treatment group (32.9%) than in deferred selective group (47.5%) before PCI (x2=3.58, P＜0.05); while the results of TIMI grade 0-1 flow (26.8% vs. 25.0%) and cTFC levels (34.2±11.8 vs. 34. 9±12. 7) before PCI were similar between the two groups (x2 =0. 07, P=0.47; t= 0.13, P=0.71, respectively). No differences were seen both in composite end point events at 30 days and bleeding complications (x2 = 0.31, P＞0.05; x2=0.004, P＞0. 05). Conclusions High -risk ACS patients treated with an early invasive strategy, routine upstream use of tirofiban are associated with improved tissue-level perfusion before PCI and does not increase bleeding complications when bleeding risks are carefully evaluated before enrollment.
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Objective To investigate the changes in platele aciveation in terms of platelet fibrinogen receptor expression(PAC-1),P-selectin(CD62P),Thromboxane B2(TXB2),Endothlin(ET-1),Fibrinogen(FIB)in patients undergoing elective Sirolimus-eluting stents implantation and dual anti-platelet therapy.Methods Forty in-hospital patients with stable coronary heart disease(CHD)were enrolled in this study.Dural anti-platelet therapy with aspirin and clopidogrel were prescribed at least three days before operation to achieve sufficient inhibition of platelet activation in all patients.Peripheral artery blood samples were collected before the procedures,immediately and at 6 hours and 24 hours after the procedure,levels of PAC-1,CD62P,TXB2,ET-1 and FIB were measured.All patients were followed up for 6-12 months.Results Expression of PAC-1 and CD62P was increased significantly after stenting compared with pre-stenting and the peak appeared at 6 hours post-operation(PAC-1,P=0.001,CD62P,P=0.007,PAC1+CD62P,P=0.003).TXB2 was also increased and the peak appeared at 24 hours post operation(P=0.021).Plasma levels of ET-1 and FIB showed no difference before and after stenting.After CAG,expression of PAC-1 and CD62P,levels of TXB2,ET-1 and FIB had no significant differences compared with pre-CAG.No MACE happened in all patients.Conclusion The routine dual anti-platelet therapy cannot suppress platelet activation after elective coronary Sirolimus-eluting stents implantation.Plasma FIB and ET-1 levels were not affected by stents implantation.