Effects of intracoronary arterial injection of tirofiban on no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction underwent primary percutaneous coronary intervention

Abstract

Objective: To compare the effect of intracoronary arterial injection of tirofiban and sodium nitroprusside (SNP) on no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction (STEMI) underwent primary percutaneous coronary intervention (PCI).

Methods: A total of 68 patients with acute STEMI who had no-reflow phenomenon during PCI were chosen and randomly divided into SNP group (n = 34) and tirofiban group (n = 34). Aiming at no-reflow phenomenon during PCI, with the use of microcatheters, intracoronary arterial injection of tirofiban was given in tirofiban group, while intracoronary bolus of SNP was given in SNP group. Coronary angiography was conducted to record TIMI flow grade of the infarct-related artery after 10 minutes. Plasma brain natriuretic peptide (BNP) was monitored before and after PCI (in 24 hours). With the help of ultrasound cardiogram, left ventricular ejection fraction (LVEF), left ventricular end-diastolic dimension (LVEDD) and left ventricular endsystolic dimension (LVESD) were recorded and compared in 30 days after PCI.

Results: The ratio of TIMI grade 3 blood flow in tirofiban group was significantly higher than that in SNP group [76.5% (26/34) vs. 52.9% (18/34), p = .03]. BNP levels in two groups had no statistical significance before PCI (p = .16), but in 24 h after PCI, BNP levels in tirofiban group were significantly lower than those in SNP group [(439.00 ± 4.90) μmol/L vs. (632.00 ± 3.63) μmol/L, p = .02]. In 30 days after PCI, LVEF, LVEDD and LVESD in tirofiban group were all superior to those in SNP group (all p < .05).

Conclusions: Intracoronary arterial injection of tirofiban was superior to SNP in improving no-reflow phenomenon in STEMI patients after PCI in the emergency treatment. Tirofiban therapy can increase coronary blood flow and myocardial perfusion after the occurrence of no-reflow phenomenon during PCI in STEMI patients, and improve long-term prognosis.