Effect of intracoronary tirofiban bolus administration on platelet-derived microparticles and short-term clinical benefit in patients with acute ST-segment elevation myocardial infarction / 中华老年医学杂志

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.