ABSTRACT
ObjectiveTo evaluate the safety and efficacy of firofiban in gerontal patients with acute coronary syndrome(ACS). MethodA total of 106 elderly patients with ACS admitted form December 2006 to June 2008 were enrolled in a prospective case-control study. Patients were divided into percutaneous coronary intervention (PCI) group and medicine group. Both groups were randomly divided into two sub-groups, tirofiban sub-group and placebo sub-group. Patients in the PCI group received tirofiban infused in dose of 10 μg·kg- within 3 minutes as loading dose before operation and then an infusion of 0.15μg'kg-1·min-1 as maintenance dose for 24～36 hours. In medicine group,the loading dose was 0.4 μg·kg-1·min-1×30 min and the maintaining dose was 0.1 μg·kg-1·min-1×48 hours, The rates of major adverse cardiac events (MACE) consisting of death, myocardial infarction or refractory ischemia during hospital stay stay and 30 days' follow-up, bleeding rates TIMI grade, corrected TIMI frame count (CTFC) and myocardial blush grade(MBG) after PCI were compared between sub-groups of PCI group. ResultsThe basic clinical data were similar among the sub-groups. In medicine group,the MACE rate during 30 days' follow-up was much lower in the tirofiban sub-group than in the placebo sub-group (12.0% vs. 36.4 %, P < 0.05). In comparison with medicine group, in PCI group, there were fewer TIMI frames [(23.5 ±5.1) frames vs. (31.4±5.2) frames, P < 0.01] and higher percentage of myocardial blush grade 3(64.3% vs. 29.0%, P < 0.01) in firotiban sub-group of PCI group. No significant differences in bleeding rates were found between all sub-groups. ConclusionsTirofiban is safe and effective in gerontal ACS patients with blood flow and reperfusion improved.
ABSTRACT
Objective Myocardial blush grade (MBG) as a new angiographic parameter was used to describe the effectiveness of myocardial reperfusion in patients treated with thrombolysis for acute myocardial infarction (AMI) Methods Eighty nine patients received a small dose alteplase 50mg within 12 hours of acute infarction Coronary angiography was performed at 90 min after the initiation of thrombolytic therapy to evaluate infarct related artery (IRA) patency and myocardial reperfusion Cardiac events during a 6 month period were recorded Results There were 87 6% and 12 4% patients with and without successful clinical recanalization after thrombolysis respectively Coronary angiography showed that 82 6% patients with TIMI flow 2 or 3, 88 8% patients with MBG 2 or 3, and 40 4% patients with TIMI flow 3 and MBG 3 Mortality at follow up was 10 1% Multivariate analysis showed that the MBG and Killip grade at admission were major significant predictors of 6 month mortality Conclusion The primary objective of reperfusion therapies is not only restoration of blood flow in the epicardial coronary artery, but also complete reperfusion of the infarcted myocardium