Influence of tirofiban on patients with acute ST-segment elevation myocardial infarction complicated by type 2 diabetes mellitus

Xiao Liyun; Li Xiuli

doi:10.3969/j.issn.1674-4055.2017.11.11

Abstract：Objective To analyze the influence of tirofiban on patients with acute ST-segment elevation myocardial infarction (STEMI) complicated by type 2 diabetes mellitus (T2DM). Methods The patients with acute STEMI complicated by T2DM (n=524, male 310, female 214, aged from 35 to 78 and average age=55.7± 11.8) were chosen from the Department of Cardiology of People's Hospital of Jinxiang County from Jan. 2012 to Jan. 2014. All patients were randomly divided into group A and group B (each n=262). Two groups were given emergency percutaneous coronary intervention (PCI), and group A was given stenting and group B was additionally given local tirofiban injection maintained for 24 h. The reperfusion status was reviewed by using thrombolytic test for myocardial infarction (TIMI) and corrected TIMI frame count (CTFC), and ST-segment resolution was detected by using electrocardiogram (ECG). The levels of cardiac troponin I (cTnI), creatine kinase-MB isoenzyme (CK-MB) and myoglobin (MYO) were detected after the operation for 2 h. The changes of interleukin-6 (IL-6), C-reactive protein (CRP) and brain natriuretic peptide (BNP) were detected before and after the operation for 3 d. The levels of left ventricular ejection fraction (LVEF), left ventricular end-systolic volume (LVESV) and left ventricular end-diastolic volume (LVEDV) were detected by using echocardiogram after the operation for 1 week, 6 months and 1 y. The bleeding events and major adverse cardiovascular events (MACE) were recorded after the operation for 1 month. Results The percentage of patients with slow flow and no reflow decreased, and percentage of patients with slow flow and fast flow of TIMI grade 3 increased in group B compared with group A (all P<0.05). The levels of CK-MB, cTnI and MYO decreased, and percentage of ST-segment resolution increased in group B compared with group A (all P<0.05). The levels of CRP, IL-6 and BNP increased in 2 groups after the operation, which was more significant in group A (all P<0.05). The comparison in LVESV, LVEDV and LVEF had no statistical difference between group A and group B after the operation for 1 week (all P>0.05). LVESV and LVEDV decreased and LVEF increased in group B compared with group A after the operation for 6 months and 1 y (all P<0.05). There were 48 cases of bleeding in group B and 27 in group A (18.3% vs. 10.3%, P>0.05). The incidence of MACE was higher in group A than that in group B (11.8% vs. 1.5%). Conclusion Tirofiban administrated during emergency PCI can significantly improve post-operation coronary flow, relieve myocardial injury and inflammatory reactions and promote heart function with higher safety in patients with STEMI complicated by T2DM.