Efficacy of thrombus aspiration catheterization and tirofiban interventional treatment during convalescent phase of acute myocardial infarction

Abstract

Objective To determine the efficacy of thrombus aspiration catheterization and coronary injection of tirofiban and nitroglycerin via percutaneous coronary intervention (PCI) in patients during convalescent phase of acute myocardial infarction (AMI).Methods A total of 250 patients with AMI during convalescent phase admitted to The First Affiliated Hospital of Zhengzhou University,between September 2009 and September 2012,were randomly assigned to be treated with thrombus aspiration catheterization and coronary injection of tirofiban and nitroglycerin (treatment group,n=130) or conventional PCI (control group,n=120).Comparisons were made in a series of clinical indices,including the duration of surgery,grading of blood flow immediately after thrombolysis in myocardial infarction (TIMI),corrected TIMI frame count (CTFC),presence of 50％ reduction in ST segment 2 h postoperatively,postoperative levels of serum BNP and massive hemorrhage at day 7,left ventricular ejection fraction (LVEF),left ventricular end-diastolic diameter (LVEDd),left ventricular end-systolic diameter (LVESd) and major adverse cardiac events (MACE) 3 months after operation.Results The difference in the duration of operation was unremarkable between two groups [(50.76± 10.53) min vs (59.94 ± 9.78) min,P＞0.05].Compared with control group,the treatment group yielded an increased proportion of TIMI blood flow grading of 3 flow or more (94.62％ vs 85.00％,P＜0.05) and a significantly lower CTFC [(27.68±6.97) frame/s vs (38.98±5.42) frame/s,P＜0.05].There was no marked difference in the proportion of patients who evidenced a 50％ reduction in ST segment at 2 h postoperatively (64.62％ vs 63.33％,P＞0.05).The treatment group was associated with reduced levels of serum BNP at day 7 postoperatively compared with control group [(209.0±70.1) μg/L vs (298.0±69.4) μg/L,P＜0.05].No massive hemorrhage case was found in two groups.At 3-month following operation,echocardiography evidenced an increased LVEF [(48.97 ±6.74)％ vs (39.42±9.56)％,P＜0.05],reduced LVEDd [(47.58±5.94) mm vs (50.46±6.78) mm,P＜0.05] and reduced LVESd [(24.76±3.21) mm vs (26.84±3.67) mm,P＜0.05] in the treatment group.There was a significantly lower incidence of MACE in treatment group as compared with control group (0.77％ vs 3.33％,P＜0.05).Conclusion Treatment with thrombus aspiration catheterization and coronary injection of tirofiban and nitroglycerin via PCI is effective in patients during convalescent phase of AMI. Key words: Angioplasty, transluminal, percutaneous coronary; Myocardial infarction; Thrombus aspiration catheter; Tirofiban