RESUMO
Objective To investigate the influence of thrombus aspiration on ventricular remodeling of patients with ST?segment elevation type of myocardial infarction ( STEMI ) who underwent emergency percutaneous coronary intervention ( PCI) and its predicative value for patients′ prognosis. Methods Three hundred and eight patients who were diagnosed with STEMI line emergency PCI and hospitalized in the Cardiology Department of Jinghai Clinical College of Medical University of Tianjin from March 2011 to March 2014 were retrospective analyzed, including 152 patients received thrombus aspiration during primary PCI as thrombus aspiration group,and the remaining 156 patients without thrombus aspiration as control group. Indexes of myocardial perfusion levels such as ST?segment resolution 2 hours after PCI and TIMI myocardial perfusion grade were measured in all patients. All patients accepted echocardiography examinations to detect left ventricular end diastolic diameter(LVED) and left ventricular ejection fraction(LVEF) 10 days after PCI. The indexes differences of the two groups,secondary end points major cardiac adverse events(MACE) at 6 months were compared. Results There was no statistical difference between the ratio of two groups for ST segment fell more than 50%( 78. 9%( 120/152) vs. 71. 2%( 111/156) ,χ2=0. 428,P=0. 669) . But for ST segment fell more than 70%,the ratio of the thrombus aspiration group was significantly higher than that in the control group ( 73. 7%( 112/152 ) vs. 47. 4% ( 74/156 ) , χ2 = 4. 701, P = 0. 001 ) . Two groups of patients were treated by echocardiography 10 days after PCI,showed the LVED in the thrombus aspiration group was lower than that in the control group((50. 2±4. 7) mm vs. (51. 6±4. 6) mm,t=2. 642,P=0. 008),while the LVEF value was higher than that in the control group((56. 9±4. 9)% vs. (49. 4±4. 2)%,t=14. 434,P=0. 001). Recurrent angina pectoris decreased significantly in the thrombus aspiration group at 6 months ( 4. 61% ( 7/152 ) vs. 10. 90%(17/156),χ2=2. 056,P=0. 040). Conclusion STEMI patients adopt thrombus aspiration that undergoing emergency PCI,not only can improve myocardial reperfusion,especially microcirculation reperfusion, but also can improve the left ventricular systolic function and the prognosis of patients.
RESUMO
ObjectiveTo investigate the effects of tirofiban on microvascular flow in infarction zone after coronary reperfusion in pigs with acute myocardial infarction (AMI),and to explore its mechanism of decreasing microvessel obstruction (MO) and the relationship with inflammatory factors. MethodsChinese mini pigs were randomized into control group and tirofiban treatment group.Acute myocardial infarction was induced by balloon occluding the medium segment of the left anterior descending artery for 90 min,and then reperfusion was created by withdrawing the balloon.The infarct myocardium and MO area were detected with delayed enhancement multi-slice spiral CT (DE-MSCT),the serum levels of IL-6 and IL-10 were measured with enzyme linked immunosorbent assay (ELISA).The pigs were killed, the heartwere excised and stained with 2, 3, 5-triphenyltetrazolium chloride (TTC). Results6 pig models were successfully established in each group.4 pigs in control group and 3 pigs in tirofiban treating group experienced MO.The MO volume was increased at every time after reperfusion in both groups,while the MO volume was significantly reduced in tirofiban treatment group compared with control group at 1 h [(9.6 ± 3.1) ％ vs.(4.8 ±0.7)％],24 h[(13.4±3.3) ％ vs.(5.8±-1.2)％],48 h[(15.1±3.8)％ vs.(6.4±1.2)％] and 72 h [(15.9±4.6) ％ vs.(6.6±0.8)％ after reperfusion (t=6.99,13.76,14.21,11.38,all P＜0.05).Compared with the baseline,the levels of serum IL-6 and IL-10 in both groups were increased at 30 min after AMI.In tirofiban treatment group,the level of serum IL-6 was significantly lower and serum IL-10 was higher than those in control group (P＜0.05 and P＜0.01) from 10 min to 72 h after reperfusion. Conclusions Tirofiban may lessen the MO area in infarction zone of AMI after reperfusion,which may be ascribed to its anti-inflammation besides anti-platelets.
RESUMO
Objective To evaluate the effcets of tirofihan on myocardial no-reflow after acute myocardial infarction and reperfusion by delayed enhancement-multi-slice CT(DE-MSCT).Methods Chinese mini pigs were randomized into control group and firofiban treatment group. Acute myocardial infarction was induced by balloon occlusion of the medium segment of the left anterior descending artery for 90 minutes. Repeffusion was created by withdrawing the balloon during angiography. All successful models received DE-MSCT examinatons at 1 h, 24 h, 48 h, and 72 h after reperfusion to observe the myocardial noreflow area. Data were analyzed with Spearman rank correlation and Wilcoxon Rank Sum test. Results Six pigs were successfully induced as acute reperfusion myocardial infarction in each group. Furthermore,4 pigs in control group and 3 pigs in firofiban treatment group had no-reflow phenomenon. The no-reflow volume percent increased from 1 h to 72 h in both groups. The no-reflow volume percent was significantly reduced in tirofiban treatment group compared with control group after reperfusion at 1 h, 24 h, 48 h and 72 h respectively[(4.78±0.66)% and (9.62±3.05)%, t =6.000, P＜0.05; (5.84 ± 1.19)% and (13.44±3.33)% ,t=6.000,P＜0. 05;(6.41± 1.24)% and (15.10±3.76)%,t =6.000,P ＜0.05;(6.63 ±0. 82)% and (15.94 ±4.62)% ,t =6.000,P ＜0.05] ,as well as the infarct myocardium volume percent was significantly reduced in tirofiban treatment group compared with control group at 24 h, 48 h and 72 h after reperfusion [ (19.74± 2. 94) % and ( 25.08 ± 4.68) %, t = 25.000, P ＜ 0.05;(20.34±2.46) % and (27.07 ±5.44)%, t =26. 000,P ＜0.05; (20.72 ±2.10)% and (26.17 ±5.19)% ,t = 24.000,P ＜0.05]. Conclusions DE-MSCT can be used to detect the extent of no-reflow phenomenon. Tirofiban can reduce the volume of myocardial infarct and no-reflow area after reperfusion.