2Department of Cardiology, Faculty of Medicine, Gülhane Military Medical Academy, Ankara-Turkey
3Department of Biostatistics, Faculty of Medicine, Çukurova University, Adana
4Department of Cardiology, Faculty of Medicine, Acıbadem University, Adana
Abstract
Objective: This study aimed to investigate the relationship of tirofiban, added to the treatment of acute ST-elevation myocardial infarction (STEMI) patients underwent primary percutaneous coronary intervention (PCI), with changes in the TIMI risk index (TRI) of TIMI flow, B-type natriuretic peptide (BNP) and high-sensitive C-reactive protein (hs-CRP) levels. Materials and Methods: This single-center, prospective observational cohort study included 102 consecutive patients who were admitted with the diagnosis of acute STEMI (70 male; 54.9±10.4 years). Primary PCI was applied to all cases with STEMI, who applied to our hospital in the first 6 hours due to chest pain complaints. Tirofiban was administered to one group (n=55) (male: 36; 54.1±11.3 years), while the other group was not given tirofiban (n=47) (male: 34; 55.9±9.1 years). The primary end-point was TIMI flow 2 or 3 for reperfusion after primary PCI. Chi-square test, paired t-test or Wilcoxon signed rank test, Spearman correlation analysis and Kaplan-Meier survival analysis were used for statistical analysis where appropriate. Results: BNP level remained the same in the tirofiban group, whereas a significant increase was observed in the group that was not treated with tirofiban (105.9±126.8 versus 261.3±202.3 pg/ml p<0.001). The hs-CRP level tended to rise significantly in both groups despite the treatment (tirofi- ban group - from 0.67±0.66 to 0.90±0.44 mg/L, p=0.015, non tirofiban group - from 0.51±0.43 to 1.08±0.74 mg/L, p<0.001). BNP and hs-CRP values remained the same in cases with TIMI 2 flow in the tirofiban group, whereas a significant increase was detected in the post-treatment BNP (before 97.8±122.3 after 281.6±217.3 pg/ml, p=0.011) and hs-CRP (before 0.65±0.69; after 1.33±0.80 mg/L, p=0.028) values in the group not treated with tirofiban. In patients with TIMI 3 flow, BNP (tirofiban group before 146.5±114.2; after 184.4±139.4 pg/ml, p=0.011, non tirofiban group before 172.1±297.9; after 295.9±384.9 pg/ml, p<0.001) and hs-CRP levels (tirofiban group before 0.66±0.58; after 0.92±0.65 mg/L, p=0.011, non tirofiban group before 0.81±0.74; after 1.45±1.23 mg/L, p<0.001) were found to be similarly reduced in both treatment groups p<0.05. Three patients with minor hemorrhage did not need blood transfusion. Conclusion: It was concluded at the end of them PCI application in STEMI that the addition of tirofiban treatment in patients with ≥TIMI 2 flow and anterior location MI could decrease the expected rise in BNP and CRP values.
2Department of Cardiology, Faculty of Medicine, Gülhane Military Medical Academy, Ankara-Turkey
3Department of Biostatistics, Faculty of Medicine, Çukurova University, Adana
4Department of Cardiology, Faculty of Medicine, Acıbadem University, Adana
Amaç: Bu çalışmada primer perkütan koroner girişim (PPCI) uygulanan akut ST elevasyonlu miyokart enfarktüslü olgularda (STEMI) tedaviye ekle- nen tirofibanın anjiyografik TIMI akım (The Thrombolysis in Myocardial Infarction), TIMI risk indeksi, serum B-tip natriüretik peptit, (BNP) ve yüksek- duyarlıklı C-reaktif protein (hs-CRP) düzeyleriyle ilişkisi araştırılmıştır. Yöntemler: Bu tek merkezli, prospektif gözlemsel kohort’una akut STEMI tanısıyla kabul edilen ardışık 102 hasta [70 erkek, ort. yaş 54.9±10.4 yıl, (30-82 yaş), mediyan yaş 54 yıl] çalışmaya alındı. İlk 6 saat içinde başvuran tüm STEMI’lılara PPCI uygulandı. Hastaların bir grubuna tirofiban (n=55) (erkek: 36, 54.13±11.39 yıl) diğer gruba ise, standart tedavi (n=47) (erkek: 34, 55.98±9.16 yıl) uygulandı. Tüm hastaların TIMI indeksi ve TIMI akım dereceleri kayıt edildi. Reperfüzyon için TIMI 2 veya 3 akım sağlamak anjiyografik endpoint olarak kabul edildi. İstatistiksel analiz için Ki-kare, eşleş- tirilmiş t, Wilcoxon işaret sıralama ve Spearman korelasyon testleri ve Kaplan-Meier sağkalım analizi kullanıldı. Bulgular: BNP seviyeleri tirofiban alan grupta aynı kalırken, tirofiban almayan grupta bu artış devam ettiği görüldü (105.9±126.8 karşı 261.3±202.3 pg/ ml p<0.001). Buna karşın tirofiban tedavisi alan her iki grupta hs-CRP seviyeleri yükselme eğilimindeydi (tirofiban alan grup-0.67±0.66‘dan, 0.90±0.44‘e mg/L, p=0.015, tirofiban almayan grup - 0.51±0.43‘den 1.08±0.74’e mg/L, p<0.001). TIMI 2 akıma sahip tirofiban alan grupta BNP and hs-CRP değer- leri benzer kalırken, tirofiban almayan gruplarda tedavi sonrası BNP (öncesi, 97.8±122.3 sonrası, 281.6±217.3 pg/ml, p=0.011) ve hs-CRP (öncesi 0.65±0.69; sonrası 1.33±0.80 mg/L, p=0.028) değerlerinde yükselme eğilimi tespit edildi. TIMI 3 akıma sahip olgularda, BNP (tirofiban alan grup öncesi, 146.5±114.2; sonrası 184.4±139.4 pg/ml, p=0.011, tirofiban almayan grup öncesi 172.1±297.9; sonrası 295.9±384.9 pg/ml, p<0.001) ve hs-CRP seviyesi (tirofiban alan grup öncesi 0.66±0.58; sonrası 0.92±0.65 mg/L, p=0.011, tirofiban almayan grup öncesi 0.81±0.74; sonrası 1.45±1.23 mg/L, p<0.001) her iki grupta benzer azalmalar tespit edildi p<0.05. Üç hastada kan transfüzyonu gerektirmeyen minör kanama oldu Sonuç: Çalışmamızda STEMI’de uygulanan PPCI sonucunda, ≥ anjiyografik TIMI 2 akıma sahip olgularda tirofiban tedavisinin eklenmesinin BNP ve CRP değerlerinde beklenen artışın tirofiban tedavisi ile bir miktar da olsa azaltabildiği görüşü ortaya çıkmıştır.