title: [Efficiency and safety of thrombus aspiration plus intra-infarct-related artery administration of tirofiban during primary angioplasty].
abstract: OBJECTIVE
  To investigate whether thrombus aspiration plus intra-infarct-related artery bolus administration of tirofiban via the aspiration catheter is superior to thrombus aspiration alone in improving myocardial perfusion in patients with ST-elevation myocardial infarction (STEMI) undergoing primary angioplasty.
  
  
  METHODS
  In this single center retrospective study, 108 patients with STEMI who underwent angioplasty after thrombus aspiration plus intra-infarction related artery 500 µg tirofiban administration, with subsequent 12-hour intravenous infusion of 0.1 µg×kg(-1)×min(-1) after angioplasty (thrombus aspiration + tirofiban group) and 108 matched control patients with STEMI who underwent angioplasty after thrombus aspiration (thrombus aspiration group). The primary end points included thrombolysis in myocardial infarction (TIMI) flow immediately after angioplasty, complete ST-segment elevation resolution (> 70%) at 90 minutes after angioplasty and the peak of creatine kinase-MB (CK-MB) and troponin I (TnI). The secondary end points were the left ventricular ejection fraction (LVEF) in the hospital and at 9 months follow-up as well as major adverse cardiac events (MACE: cardiac death, target vessel revascularization, re-infarction) at 9 months and any bleeding events.
  
  
  RESULTS
  Baseline characteristics of the two groups were well-balanced. The TIMI 3 flow rate (97.22% vs. 87.04%, P = 0.011) and the complete ST-segment resolution rate (66.67% vs. 50.91%, χ(2) = 6.129, P = 0.047)were significantly higher in the thrombus aspiration + tirofiban group than in the thrombus aspiration group. The peak of CK-MB (83.9 U/L vs. 126.1 U/L, P = 0.034) and TnI (42.7 ng/ml vs. 72.5 ng/ml, P = 0.029) were significantly lower in the thrombus aspiration + tirofiban group than in the thrombus aspiration group. LVEF in the hospital favored thrombus aspiration + tirofiban the group (45.7% ± 10.8%, 42.9% ± 9.9%, t = 1.99, P = 0.049). There was a tendency to decreased MACE rate at 9-month follow-up, which favored thrombus aspiration + tirofiban the group (logrank χ(2) = 2.865, P = 0.09). Bleeding events were similar between the two groups.
  
  
  CONCLUSIONS
  Thrombus aspiration plus intra-infarct-related artery bolus administration of tirofiban in patients with STEMI undergoing primary angioplasty may improve myocardium perfusion, attenuate myocardial ischemia and result in a better clinical prognosis compared to thrombus aspiration alone.
authors.affiliation: Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
authors.forename: Shi-ying
authors.initials: SY
authors.lastname: Li
authors.forename: Hong-bing
authors.initials: HB
authors.lastname: Yan
authors.forename: Jian
authors.initials: J
authors.lastname: Wang
authors.forename: Li
authors.initials: L
authors.lastname: Song
authors.forename: Zheng
authors.initials: Z
authors.lastname: Wu
authors.forename: Yun-peng
authors.initials: YP
authors.lastname: Chi
authors.forename: Bin
authors.initials: B
authors.lastname: Zheng
authors.forename: Han-jun
authors.initials: HJ
authors.lastname: Zhao
authors.forename: Qing-xiang
authors.initials: QX
authors.lastname: Li
authors.forename: Xiao-jiang
authors.initials: XJ
authors.lastname: Zhang
authors.forename: Wen-zheng
authors.initials: WZ
authors.lastname: Li
authors.forename: Chen
authors.initials: C
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods; D003328:Coronary Thrombosis / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D012189:Retrospective Studies; D000077466:Tirofiban; D014443:Tyrosine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D014443:Tyrosine; D000077466:Tirofiban