Effect of intracoronary tirofiban on myocardial reperfusion and endothelial function in patients with acute myocardial infarction undergoing percutaneous coronary intervention

doi:10.3877/cma.j.issn.1674-6880.2016.01.001

Abstract

Abstract:

Objective

To investigate the effect of intracoronary tirofiban on myocardial reperfusion and endothelial function in patients with acute myocardial infarction (AMI) undergoing emergency percutaneous coronary intervention (PCI).

Methods

Totally 114 patients with AMI treated by emergency PCI were divided randomly into the tirofiban group (58 cases) and control group (56 cases). In the tirofiban group, tirofiban was administered intravenously as a bolus injection at a dose of 10 μg/kg followed by intravenous infusion at 0.075 μg·kg^-1·min^-1 for 24 to 48 hours, while patients in the control group did not took tirofiban treatment. Thrombolysis in myocardial infarction (TIMI) flow grade was assessed by coronary angiography picture at the end of PCI. The levels of soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), von Willeband factor (vWF) and high-sensitivity C-reactive protein (hs-CRP) were measured by enzyme-linked immunosorbent assay (ELISA). Serial venous blood samples were obtained before and 1 day after PCI.

Results

Compared with the control group, the proportion of TIMI grade 3 flow in the tirofiban group was significantly higher (79.3% vs 50.0%, χ² = 10.747, P < 0.05). There were no statistical differences noted in the levels of sICAM-1, sVCAM-1, vWF, hs-CRP between the two groups before tirofiban treatment (all P > 0.05). 24 h after the treatment, the levels of sICAM-1[(24.2 ± 2.3) μg/L vs. (37.1 ± 3.3) μg/L], sVCAM-1[(26.2 ± 2.9) μg/L vs. (43.1 ± 3.8) μg/L]、vWF[(514 ± 135) U/L vs.(588 ± 126) U/L] in the tirofiban group were significantly lower than those in the control group (all P < 0.05); 72 h after the treatment, the levels of sICAM-1 [(22.4 ± 1.8) μg/L vs. (32.4 ± 2.5) μg/L], sVCAM-1[(23.7 ± 2.2) μg/L vs. (38.9 ± 2.6) μg/L], vWF [(586 ± 145) U/L vs. (678 ± 144) U/L], hs-CRP [(7.2 ± 2.7) mg/L vs. (8.5 ± 3.5) mg/L] in the tirofiban group were significantly lower than those in the control group (all P < 0.05).

Conclusion

Intracoronary injections of tirofiban to AMI patients during emergency PCI could improve myocardial tissue perfusion and endothelial function.

Key words: Tirofiban, Myocardial infarction, Percutaneous coronary intervention, Myocardial reperfusion, Endothelial function

Fazhan Zhou, Jun Wu, Chunling Zhang, Zhaofeng Song, Jifang Liu, Huanyi Zhang, Luhua Yin. Effect of intracoronary tirofiban on myocardial reperfusion and endothelial function in patients with acute myocardial infarction undergoing percutaneous coronary intervention[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2016, 09(01): 3-8.

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References 24

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组别	例数	年龄（岁）	男/女（例）	BMI(kg/m²)	吸烟（是/否，例）	高脂血症（是/否，例）	糖尿病（是/否，例）	高血压（是/否，例）	陈旧性心肌梗死（是/否，例）	PCI史（是/否，例）	CABG史（是/否，例）
对照组	56	63.6 ± 10.2	30/26	24.3 ± 2.2	22/34	26/30	32/24	36/20	11/45	15/41	1/55
治疗组	58	63.5 ± 10.3	34/24	25.0 ± 1.7	24/34	25/33	30/28	34/24	13/45	14/44	1/57
t/χ²值	?	0.047	0.003	1.668	0.052	0.127	0.337	0.386	0.132	0.105	-
P值	?	0.963	0.956	0.098	0.820	0.721	0.561	0.535	0.717	0.746	1.000

组别	例数	年龄（岁）	男/女（例）	BMI(kg/m²)	吸烟（是/否，例）	高脂血症（是/否，例）	糖尿病（是/否，例）	高血压（是/否，例）	陈旧性心肌梗死（是/否，例）	PCI史（是/否，例）	CABG史（是/否，例）
对照组	56	63.6 ± 10.2	30/26	24.3 ± 2.2	22/34	26/30	32/24	36/20	11/45	15/41	1/55
治疗组	58	63.5 ± 10.3	34/24	25.0 ± 1.7	24/34	25/33	30/28	34/24	13/45	14/44	1/57
t/χ²值	?	0.047	0.003	1.668	0.052	0.127	0.337	0.386	0.132	0.105	-
P值	?	0.963	0.956	0.098	0.820	0.721	0.561	0.535	0.717	0.746	1.000

组别	时间	例数	sICAM-1(μg/L)	sVCAM-1(μg/L)	vWF(U/L)	hs-CRP(mg/L)
对照组	PCI术前	56	17.1 ± 2.9	18.8 ± 2.7	426 ± 114	4.2 ± 2.9
	PCI术后24h	56	37.1 ± 3.3	43.1 ± 3.8	588 ± 126	6.2 ± 3.4
	PCI术后72h	56	32.4 ± 2.5	38.9 ± 2.6	678 ± 144	8.5 ± 3.5
替罗非班组	PCI术前	58	16.5 ± 3.1	18.7 ± 2.1	416 ± 120	4.5 ± 3.0
	PCI术后24h	58	24.2 ± 2.3^a	26.2 ± 2.9^a	514 ± 135^a	5.6 ± 3.4
	PCI术后72h	58	22.4 ± 1.8^a	23.7 ± 2.2^a	586 ± 145^a	7.2 ± 2.7^a

组别	时间	例数	sICAM-1(μg/L)	sVCAM-1(μg/L)	vWF(U/L)	hs-CRP(mg/L)
对照组	PCI术前	56	17.1 ± 2.9	18.8 ± 2.7	426 ± 114	4.2 ± 2.9
	PCI术后24h	56	37.1 ± 3.3	43.1 ± 3.8	588 ± 126	6.2 ± 3.4
	PCI术后72h	56	32.4 ± 2.5	38.9 ± 2.6	678 ± 144	8.5 ± 3.5
替罗非班组	PCI术前	58	16.5 ± 3.1	18.7 ± 2.1	416 ± 120	4.5 ± 3.0
	PCI术后24h	58	24.2 ± 2.3^a	26.2 ± 2.9^a	514 ± 135^a	5.6 ± 3.4
	PCI术后72h	58	22.4 ± 1.8^a	23.7 ± 2.2^a	586 ± 145^a	7.2 ± 2.7^a

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