ABSTRACT
Objective To compare the efficacy and safety between Bivalirudin and Heparin during emergency percutaneous coronary intervention(PCI)in elderly patients with acute ST segment elevation myocardial infarction(STEMI).Methods Retrospective analysis of 80 patients diagnosed with ST-segment elevation myocardial infarction in elderly patients was conducted.The treatment group(n=40) received a bolus intravenous injection of Bivalirudin 0.75 mg/kg before emergency percutaneous coronary intervention,then 1.75 mg · kg 1 · h-1 continuous intravenous drip till the end of the operation from March 2011 to March 2015.Activated clotting time (ACT)was detected at 10 minutes after drug application.If ACT＜225 s,0.3 mg/kg were append.The control group received a bolus intravenous injection of Heparin 100 U/kg during emergency PCI,and after 10 minutes ACT was detected.If ACT＜ 225 s,300 U was appended.When operation extended,1 000 U was appended every 1 hour.Immediate postoperative blood flow,early stent thrombosis,target vessel reconstruction at 30 days after operation,recurrent myocardial infarction,non-fatal cerebrovascular accident,all causes mortality and bleeding conditions at 7 days after operation were compared between two groups.Results The immediate postoperative thrombolysis in myocardial infarction (TIMI)blood flow was significantly improved(P＜0.05) in the treatment group as compared with control group.There was no significant difference in target vessel reconstruction at 30 days after operation,recurrent myocardial infarction,non-fatal cerebrovascular accident,and all-cause mortality between two groups (all P＞ 0.05).The bleeding conditions at 7 days after operation were significant lower in the treatment group [2.5％(1 case)]than in the control group[22.5％ (9 cases)] (x2 =7.31,P＜0.01).Conclusions Bivalirudin treatment does not reduce the major cardiovascular events,but improves the TIMI blood flow after surgery and the incidence of bleeding as compared with control group,which suggests that Bivalirudin is safer in emergency PCI therapy in elderly patients with acute ST-segment elevation myocardial infarction
ABSTRACT
Objective To investigate the effect of intracoronary tirofiban bolus administration on platelet-derived microparticles (PMPs) and its correlation with the short term clinical benefit in patients with acute ST-segment elevation myocardial infarction (ASTEMI) undergoing emergency percutaneous coronary intervention (PCI).Methods A total of 90 patients with ASTEMI undergoing emergency PCI were selected and randomized into the intracoronary group (intracoronary tirofiban 10.00 μg/kg bolus within 1-3 min followed by intravenous continuous infusion at 0.15 μg· kg-1 · min-1 for 36 h,n＝ 30),intravenous group (intravenous tirofiban 10.00 μg/kg bolus within 1-3 min followed by intravenous continuous infusion at 0.15 μg· kg-1 · min-1 for 36 h,n＝30) and control group (without tirofiban administration,n＝ 30).The 3 ml blood samples from coronary artery were obtained before and 10 min after tirofiban infusion.The 3 ml blood samples from radial artery were collected 24 hours after tirofiban infusion and 12 hours after drug withdrawal.The counts of PMPs were analyzed by flow cytometry.The thrombolysis in myocardial infarction (TIMI) flow grade classification and TIMI Myocardial Perfusion Grade in the culprit blood vessel after PCI,and the incidences of bleeding and major adverse cardiac events (MACE) within 30 days after surgery were recorded.Results There was no significant difference in baseline of PMPs among intracoronary group,intravenous group and control group (all P＞0.05).The level of PMPs was decreased in the intracoronary and intravenous group as compared with the control group [(3.6 ±2.3)％,(5.1±2.7)％ vs.(6.7±3.2)％,P＜0.01 or 0.05] 10 min after tirofiban infusion.The PMPs were lower in intracoronary group than in intravenous group (P＜0.05).At 24 hours after tirofiban infusion,the levels of PMPs in intracoronary versus intravenous groups were similar (P＞0.05),and PMPs levels were lower in intracoronary and intravenous group than in control group (both P＜0.05).The levels of PMPs had no significant diferences among the 3 groups at 12 hours after drug withdrawal (P＞0.05).Immediately after PCI,the TIMI flow grade and TIMI myocardial perfusion grade in the culprit blood vessel in intracoronary group were superior to those in the intravenous group and control group (P＜ 0.05 or 0.01).There was no statistically significant difference in the total incidence of MACE among the three groups (P＞0.05).Conclusions The intracoronary versus intravenous tirofiban administration can effectively and immediately reduce the number of PMPs in patients with acute ST-segment elevation myocardial infarction undergoing emergency interventional treatment,quickly inhibit the activated platelets,and decrease the total major adverse cardiovascular events without increasing the risk of bleeding.