title: Comparison of tirofiban combined with dalteparin or unfractionated heparin in primary percutaneous coronary intervention of acute ST-segment elevation myocardial infarction patients.
abstract: BACKGROUND
  Primary percutaneous coronary intervention (PCI) is the best treatment of choice for acute ST segment elevation myocardial infarction (STEMI). This study aimed to determine the clinical outcomes of tirofiban combined with the low molecular weight heparin (LMWH), dalteparin, in primary PCI patients with acute STEMI.
  
  
  METHODS
  From February 2006 to July 2006, a total of 120 patients with STEMI treated with primary PCI were randomised to 2 groups: unfractionated heparin (UFH) with tirofiban (group I: 60 patients, (61.2 ± 9.5) years), and dalteparin with tirofiban (group II: 60 patients, (60.5 ± 10.1) years). Major adverse cardiac events (MACE) during hospitalization and at 4 years after PCI were examined. Bleeding complications during hospitalization were also examined.
  
  
  RESULTS
  There were no significant differences in sex, mean age, risk factors, past history, inflammatory marker, or echocardiography between the 2 groups. In terms of the target vessel and vascular complexity, there were no significant differences between the 2 groups. During the first 7 days, emergent revascularization occurred only in 1 patient (1.7%) in group I. Acute myocardial infarction (AMI) occurred in 1 (1.7%) patient in group I and in 1 (1.7%) in group II. Three (5.0%) patients in group I and 1 (1.7%) in group II died. Total in-hospital MACE during the first 7 days was 4 (6.7%) in group I and 2 (3.3%) in group II. Bleeding complications were observed in 10 patients (16.7%) in group I and in 4 patients (6.7%) in group II, however, the difference was not statistically significant. No significant intracranial bleeding was observed in either group. Four years after PCI, death occurred in 5 (8.3%) patients in group I and in 4 (6.7%) in group II. MACE occurred in 12 (20.0%) patients in group I and in 10 (16.7%) patients in group II.
  
  
  CONCLUSIONS
  Dalteparin was effective and safe in primary PCI of STEMI patients and combined dalteparin with tirofiban was effective and safe without significant bleeding complications compared with UFH. Although there was no statistically significant difference, LMWH decreased the bleeding complications compared with UFH.
authors.affiliation: The Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing 100020, China.
authors.forename: Wei-Ming
authors.initials: WM
authors.lastname: Li
authors.forename: Xin-Chun
authors.initials: XC
authors.lastname: Yang
authors.forename: Le-Feng
authors.initials: LF
authors.lastname: Wang
authors.forename: Yong-Gui
authors.initials: YG
authors.lastname: Ge
authors.forename: Hong-Shi
authors.initials: HS
authors.lastname: Wang
authors.forename: Li
authors.initials: L
authors.lastname: Xu
authors.forename: Zhu-Hua
authors.initials: ZH
authors.lastname: Ni
authors.forename: Da-Peng
authors.initials: DP
authors.lastname: Zhang
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000925:Anticoagulants / Q000627:therapeutic use*; D017985:Dalteparin / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000628:therapy*; D000077466:Tirofiban; D016896:Treatment Outcome; D014443:Tyrosine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014443:Tyrosine; D006493:Heparin; D000077466:Tirofiban; D017985:Dalteparin