Short-term efficacy and safety of three different antiplatelet regimens in diabetic patients treated with primary percutaneous coronary intervention: a randomised study.

BACKGROUND AND AIM: This study aimed to investigate the efficacy and safety of dual and triple antiplatelet therapy (DAPT and TAPT) in patients with diabetes and acute ST segment elevation myocardial infarction (D-STEMI), who had undergone primary percutaneous coronary intervention (PCI). METHODS: We designed a phase IV, single-centre, randomised, double-blind, placebo-controlled study. The D-STEMI patients (n = 258) were randomly divided into three groups. Control group A (85 patients), was treated with aspirin and clopidogrel; group B (87 patients) received aspirin, clopidogrel, and tirofiban; and group C (86 patients) were treated with aspirin, ticagrelor, and tirofiban. Patients in all three groups received oral DAPT, and patients in groups B and C received intravenous tirofiban when primary PCI was performed. RESULTS: Compared to the findings in group A, the post-PCI Thrombolysis in Myocardial Infarction (TIMI) grade 3 blood flow in groups B and C increased significantly (TIMI grade 3 in groups A, B, C: 74%, 91%, and 98%, respectively; TIMI myocardial perfusion grade [TMPG] grade 3 in groups A, B, C: 59%, 86%, and 97%, respectively), and the incidence of major adverse cardiac events (MACE) decreased significantly (p < 0.05). Compared to the findings in group B, the rate of TMPG 3 in group C was significantly higher (p < 0.05) and the incidence of MACE was significantly lower (p < 0.05). Patients in group B exhibited minor bleeding; however, the incidence of mild to moderate bleeding in group C increased significantly (p < 0.05). CONCLUSIONS: TAPT effectively improved the TIMI blood flow and TMPG and reduced the occurrence of MACE. Ticagrelor was more effective than clopidogrel in TAPT; however, when using the combination of aspirin, ticagrelor, and tirofiban, close monitoring is required for possible bleeding complications.

Efficacy and safety of different doses of tirofiban combined with ticagrelor on diabetic patients with AMI receiving in emergency percutaneous coronary intervention (PCI).

OBJECTIVE: The aim of this study was to investigate the efficacy and safety of dual antiplatelet drugs combined with different doses of tirofiban on diabetic patients with acute myocardial infarction (AMI) receiving emergency percutaneous coronary intervention (PCI). METHODS: 158 diabetic patients with AMI undergone emergency PCI were randomly divided into three groups: Group A (53 cases) as the control group-dual anti-platelet agents (aspirin + ticagrelor); Group B (52 cases)-dual anti-platelet agents + conventional dose of tirofiban [10 µg/kg by PCI and 0.15 µg/(kg·min) by continue venous pump for 24 h]; Group C (53 cases)-dual antiplatelet agents + half-dose tirofiban [10 µg/kg by PCI and 0.075 µg/(kg·min) by continue venous pump for 24 h]. RESULTS: Compared with group A, thrombolysis in myocardial infarction 3 (TIMI3) blood flow and TIMI myocardial perfusion grade 3 (TMPG3) myocardial perfusion of patients in group B and group C after PCI was significantly higher (P < 0.05), the average day of hospitalization was significantly shorter (P < 0.05), reinfarction during hospitalization, post-infarction angina, severe arrhythmia, the incidence of cardiac function above KillipIII level was significantly lower (P < 0.05). And the differences between group B and C was not statistically significant (P > 0.05). Severe bleeding and moderate incidence of bleeding in group B was significantly higher than that in group A and group C (P < 0.05). CONCLUSIONS: Based on combination of dual the anti-platelet agents and ticagrelor for diabetic patients with AMI receiving PCI, the combination of half-dose tirofiban can effectively improve TIMI flow and TMPG myocardial tissue perfusion, and reduce the incidence of major adverse cardiac events (MACE) and severe bleeding.

Comparison of primary coronary percutaneous coronary intervention between Diabetic Men and Women with acute myocardial infarction.

OBJECTIVE: This study aimed to explore the short-term efficacy and safety of primary percutaneous coronary intervention (PCI) in female diabetic patients complicated with acute myocardial infarction (AMI). METHODS: A total of 169 diabetic patients with AMI who underwent primary PCI were selected and divided into group A (52 females) and group B (117 males). The clinical data, characteristics of coronary artery lesions, lengths of hospital stay, and incidences of complications were then compared between two groups. RESULTS: The average age, history of hyperlipidemia, double branch lesions, triple branch lesions, and left main lesions were significantly higher in group A than in group B (P < 0.05). Smoking history, PCI history, and pre-infarction angina were distinctly lower in group A than in group B (P < 0.05). Thrombolysis in myocardial infarction 3 (TIMI3) flow and TIMI myocardial perfusion grade 3 (TMPG3) after PCI were markedly lower in group A than in group B (P < 0.001). Group A had a higher incidence of complications, such as severe arrhythmia, cardiac function Killip III/IV, cardiogenic shock, major, moderate and mild bleed event, as well as a 30-day mortality rate, compared with group B (P < 0.05). CONCLUSION: In summary, our study demonstrated that female diabetic patients with AMI had lower TIMI3 flow and TMPG3 following PCI than male patients, while there was higher incidence of complications and 30-day mortality rate. Therefore, more attention should be paid to the therapy of diabetic women with acute myocardial infarction as well as the control of risk factors.

Effects of Coronary Arterial Injection of Tirofiban on Diabetes Mellitus Complicated with Acute Myocardial Infarction in the Elderly.

OBJECTIVE: This work aims to explore the short-term efficacy and safety of coronary arterial injection of tirofiban in elderly diabetic patients complicated with acute myocardial infarction (AMI) who underwent emergency percutaneous coronary intervention (PCI). METHODS: Ninety-seven elderly diabetic patients complicated with ST-elevation myocardial infarction (STEMI) who underwent emergency PCI were selected and randomized into control (group A, 49 cases) and tirofiban (group B, 48 cases) groups. Another 129 nonelderly diabetic patients (group C) complicated with STEMI who underwent emergency PCI and tirofiban treatment in the corresponding period were also involved for comparison. RESULTS: Thrombolysis in myocardial infarction 3 (TIMI3) flow was significantly higher in groups B and C than in group A after PCI (p < 0.01). TIMI myocardial perfusion grades (TMPG) 0 to 1 and 2 were distinctly lower (p < 0.01, p < 0.05) and TMPG3 was obviously higher (p < 0.01) in groups B and C than in group A. The average length of hospital stay, post-infarction angina pectoris, severe arrhythmia, and cardiac function Killip III to IV were markedly lower in groups B and C than in group A (p < 0.01, p < 0.05). Meanwhile, mucocutaneous hemorrhage was significantly higher in groups B and C than in group A (p < 0.01). CONCLUSIONS: Tirofiban effectively improved TIMI flow and TMPG perfusion in elderly diabetic patients complicated with AMI and reduced the incidence of serious complications without increasing the occurrence of severe hemorrhage. KEY WORDS: Acute myocardial infarction; Diabetes mellitus; Emergency percutaneous coronary intervention; Tirofiban.