Abstract: Objective To observe the effect of sequential intracoronary infusion of bivalirudin and tirofiban on no-reflow or slow blood flow in patients with acute ST-segment elevation myocardial infarction(STEMI) undergoing coronary artery intervention. Methods 108 STEMI patients undergoing no-reflow or slow blood flow during anticoagulation with bivalirudin, according to the different use of anticoagulants during operation, were divided into three groups including coronary artery group A (36 cases), coronary artery group B (38 cases) and coronary artery group C (34 cases). Coronary blood flow classification, ST-segment depression, left ventricular end diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF) were compared between the three groups after coronary angiography. The major adverse cardiovascular events (MACE) and the bleeding events during hospitalization and the incidence of thrombocytopenia were assessed. Results The proportions of TIMI 3 grade and ST-segment in the three groups were all highest in coronary artery group A, the lowest in coronary artery group C. The difference was statistically significant (P <0.05). At 3 months and 6 months after PCI, LVEDD gradually decreased and LVEF gradually increased. After 6 months, LVEDD was the shortest in coronary artery group A, and coronary artery group C was the longest. The LVEF coronary artery was the largest in coronary artery group A, and the smallest in coronary artery group C. The difference was statistically significant (P <0.05). The incidences of bleeding in coronary artery group A, B and C were 8.33%, 5.26% and 5.88%. The difference was not statistically significant(P>0.05). The incidences of MACE in coronary artery group A, B and C were 13.89%, 31.58% and 41.18%. Within 1 month after PCI, the incidence of MACE in coronary artery group A was significantly lower than that in coronary artery group B and coronary artery group C(P <0.05), but there was no significant difference between coronary artery group B and coronary artery group C (P >0.05). There was no significant difference in the thrombocytopenia among coronary artery group A, B and C (P >0.05). Conclusion Sequential intracoronary bivalirudin and tirofiban have significant efficacy in PCI with STEMI without increasing the risk of hemorrhage and thrombocytopenia, which can significantly improve the short-term clinical efficacy.

Key words: bivalirudin, tirofiban, ST-segment elevation myocardial infarction(STEMI), percutaneous coronary intervention(PCI)