Objective To compare the outcomes of IIb/IIIa antagonist assisted PCI within 12–72 h of onset with that of selective PCI within 7–10 days in STEMI patients.
Methods Totally, 80 patients were randomly allocated into the delayed PCI group (n=38) and the selective PCI group (n=42). In the delayed PCI group, PCI was performed within 12–72 h of onset. Tirofiban (10 μg/kg) was administered intravenously over 3 min immediately before PCI, and then was intravenously administered at 0.15 μg/kg/min during the procedure and for at least 36 h after PCI. In selective PCI group, PCI was performed within 7–10 days of onset. Blood platelet aggregation rate (PAR) was measured immediately before PCI (time 0) and at sequently different time points (30 min, 2 h, 6 h, 12 h, 48 h and 7 days). Final TIMI grade flow (TGF), corrected TIMI frame count (CTFC) and TIMI myocardial perfusion grade (TMPG) of the infarction related artery were recorded. Ultrasonic cardiography (1 week and 12 week after PCI) and raidonuclear ventricle imaging (RNVI) (1 week after PCI) parameters such as left ventricular peak ejection rate (LPER), left peak filling rate (LPFR), left ventricular time to peak ejection rate (LTPER) and left ventricular time to peak filling rate (LTPFR) were performed. Bleeding complications and major adverse cardiac events (MACE) were followed up for 3 months.
Results In delayed PCI group, the cases with TGF 0–1 were significantly fewer before PCI, while the cases with TGF 3, TMPG 3 were more and CTFC was lower after PCI. The LPER, LPFR 1 week after PCI in delayed PCI group was higher and the LTPER, LTPFR were lower. LVEDD at 1 week and 3 months after PCI was all significantly smaller, while the LVEF was higher. There were no significant difference between the two groups regarding the incidence of hemorrhagic complications and MACEs.
Conclusion Tirofiban facilitated delayed PCI for patients with STEMI of over 12 h of symptom onset is safe and effective.
- Delayed PCI
- selective PCI
- IIb/IIIa inhibitor
- acute myocardial infarction