Influences of different dose of tirofiban for acute ST elevation myocardial infarction patients underwent percutaneous coronary intervention

Wang, Haixia; Feng, Meiqin

doi:10.1097/md.0000000000020402

Cited by 17 publications

(23 citation statements)

References 32 publications

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“…e left ventricular systolic function and diastolic function are related to the LVEF, LVEDD, and LVESD [41]. e study demonstrated that at day 30 after PCI, the LVEF, LVEDD, and LVESD values in the mediumdose group treated with 10 μg/kg tirofiban were superior to those in the control group treated without tirofiban, and the LVEF in the medium-dose group was higher than that in the low-dose group treated with 5 μg/kg tirofiban [42]. We found that there was no significant difference on the LVEDD and LVESD in the PCI + tirofiban group and the PCI group at day 7 after PCI, but the LVEF value was higher in the PCI + tirofiban group compared with the PCI group.…”

Section: Discussionmentioning

confidence: 99%

Improved Cardiac Function and Attenuated Inflammatory Response by Additional Administration of Tirofiban during PCI for ST-Segment Elevation Myocardial Infarction Patients

Zhang¹,

Ding²

2021

Evidence-Based Complementary and Alternative Medicine

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ST-segment elevation myocardial infarction (STEMI) is one of the acute coronary syndromes, and it is the main cause of cardiac death worldwide. The purpose of this study was to investigate whether tirofiban improves cardiac function and attenuates inflammatory response in STEMI patients undergoing percutaneous coronary intervention (PCI). From May 2016 to May 2019, a total of 124 patients who admitted into our hospital due to STEMI fulfilled inclusion and exclusion criteria and were randomly assigned to PCI + tirofiban and PCI groups, 62 cases per groups. Intravenous administration of 10 μg kg−1 min−1 tirofiban was performed 30 min prior to PCI. During PCI, tirofiban infusion through a micropump with 0.15 μg kg−1 min−1 lasted for 48 h. It was found that the PCI + tirofiban group was significantly different from the PCI group in total corrected TIMI frame count (CTFC) after PCI (15.88 ± 5.11 vs. 22.47 ± 6.26, P < 0.001 ). At day 7 and day 30 post-PCI, a significant time-dependent decrease in the levels of brain natriuretic peptide (BNP), cardiac troponin I (cTnI), and creatine kinase isoenzyme (CK-MB) in both groups was observed after PCI ( P < 0.001 ). More importantly, the patients in the PCI + tirofiban group had much lower levels of BNP, cTnI, and CK-MB compared with those in the PCI group at days 7 and 30 post-PCI ( P < 0.001 ). At day 7 following PCI, the left ventricular ejection fraction (LVEF) was statistically higher in the PCI + tirofiban group than in the PCI group ( P < 0.05 ). At day 30 post-PCI, increased LVEF concomitant with reduced left ventricular end diastolic diameter (LVEDD) and left ventricular end systolic diameter (LVESD) was observed in the PCI + tirofiban group compared with the PCI group. At day 7 and day 30 post-PCI, both groups displayed a time-dependent decline in the levels of C reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and procalcitonin (PCT) after PCI ( P < 0.05 ). Additionally, the patients in the PCI + tirofiban group had lower levels of CRP, TNF-α, IL-6, and PCT compared with those in the PCI group at days 7 and 30 post-PCI ( P < 0.05 ). All patients in the PCI + tirofiban and PCI groups were followed up for 12 months by outpatient or telephone after discharge. There were fewer patients with LVEF < 50% in the PCI + tirofiban group than the PCI group ( P = 0.044 ). Furthermore, it was found that the incidence rate of major adverse cardiovascular events (MACEs) in the PCI + tirofiban group was evidently lower than that in the PCI group (12.90% vs. 29.03%, P = 0.028 ). Taken together, our data suggest that additional administration of tirofiban could improve cardiac function and attenuate inflammatory response in STEMI patients undergoing PCI, which is worthy of promotion in clinic.

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Section: Discussionmentioning

confidence: 99%

Improved Cardiac Function and Attenuated Inflammatory Response by Additional Administration of Tirofiban during PCI for ST-Segment Elevation Myocardial Infarction Patients

Zhang¹,

Ding²

2021

Evidence-Based Complementary and Alternative Medicine

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“…Statistical analyses PASS 15.0 software was used to calculate the sample size. Indicators of myocardial perfusion were noted signi cantly improved in a high-dose treatment group (20 µg/kg) over the medium-dose group (10 µg/kg), while resolution of the Sum-STR two hours after operation was 92.21% in the high-dose treatment group and 74.07% in the medium-dose group [5]. In our study, results in the IC group were expected to be consistent with those of the high-dose group.…”

Section: Follow-upmentioning

confidence: 91%

“…However, the restoration of large-vessel ow does not necessarily equate to recovery of myocardial tissue perfusion and lessening of ischemia-reperfusion injury. Studies demonstrated that serious cardiovascular adverse events, such as cardiac failure, cardiogenic shock, malignant arrhythmia, and sudden cardiac death, appear after PPCI, due to a lack of effective myocardial perfusion and insu cient oxygen supply in the myocardium [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Intracoronary Versus Intravneous Tirofiban in Acute STEMI Patients Undergoing Primary PCI

Tang

2021

Preprint

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Objective: This study aimed to investigate the effect of intracoronary tirofiban compared to intravenously administered tirofiban in acute ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PPCI).Methods: This study included 180 patients who were admitted with the diagnosis of acute STEMI and undergoing primary PCI. Patients were randomized into an observation group (n = 90) and control group (n = 90). Both groups received typical treatments, such as aspirin and clopidogrel/ticagrelor. During the procedure, the observation and control groups were administered intracoronary (IC) or intravenous (IV) injections of tirofiban, respectively, followed by an intravenous infusion of tirofiban for 24 hours. Changes in thrombolysis in myocardial infarction (TIMI) flow grading, TIMI myocardial perfusion grade 3 (TMP grade 3), thrombus aspiration, brain natriuretic peptide (BNP) levels, creatine kinase peak and inflammatory factor levels, infarct size, resolution of the sum of ST‐segment elevation (Sum‐STR) two hours after the operation, and cardiac functional parameters were investigated before and/or after treatment and 6 months after discharge. The incidence of major adverse cardiovascular events (MACE) and adverse reactions (AEs) such as bleeding were compared between the two groups.Results: There were no statistically significant differences observed in the indices of BNP, creatine kinase peak, cardiac functional parameters, thrombus aspiration, or incidence of bleeding between the two groups before treatment. Following treatment, TIMI flow grading and TMP grade 3 were improved in the observation group that received intracoronary tirofiban compared to the control group (p = 0.022 and p = 0.014, respectively). Additionally, the Sum‐umi two hours after operation in the observation group was better than that in the control group (p = 0.029). The incidence of MACEs in patients given IC tirofiban administration was lower than that in those given IV tirofiban (p = 0.012). Furthermore, levels of glutamic oxaloacetictransaminase (AST), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and myocardial troponin I (TNI) in the observation group was significantly decreased compared to the control group after five days of treatment (p = 0.039, p = 0.040, p = 0.001, and p = 0.041, respectively). Functional heart parameters including CO and LVEF were significantly improved in the observation group 6 months after discharge.Conclusion: This study found that IC administration of tirofiban in patients with STEMI who underwent PPCI improved TIMI, TMP flow and cardiac function including CO and LVEF 6 months after discharge, and reduced CRP, ESR, and TNI. However, the incidence of bleeding between the two groups was comparable. These findings suggest that IC administration should be applied in certain acute STEMI patients.

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“…According to previous literature 23 and the requirements of statistical software, the minimum sample size of low-dose, medium-dose and high-dose groups was 65 cases, 210 cases and 60 cases, respectively. The data were analyzed with SPSS version 19 (IBM, Somers, NY, USA).…”

Section: Methodsmentioning

confidence: 99%

Clinical efficacy and safety of tirofiban combined with conventional dual antiplatelet therapy in ACS patients undergoing PCI

Guo

Zhao

et al. 2021

Sci Rep

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Challenges remain for clinicians over balancing the efficacy of active antithrombotic therapy and simultaneous bleeding reduction in patients. The clinical data of 347 patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) were retrospectively analyzed. On the basis of the given tirofiban, the patients were assigned into three different dose groups: high dose group (group H), medium dose group (group M), and low dose group (group L). The tirofiban efficacy was evaluated in terms of major adverse cardiovascular event (MACE) parameters and lab endpoints, including platelet count and function. The tirofiban safety was assessed by the occurrence of bleeding events. The patients were followed up for 1 month after the PCI. No significant difference in MACE events was evident among these groups (p > 0.05). Groups H and M reported an obvious reduction in platelet count (p < 0.05 for both) and an increased platelet inhibition rate (p < 0.05 for both). Group H showed a higher rate of total bleeding events than the other groups (Group H vs. Group M: 34.4% vs. 16.5%; Group H vs. Group L: 34.4% vs. 10.3%; p < 0.05 for both). A proper administration of a low dose of tirofiban may be a superior alternative in treating ACS patients, which can produce a similar favorable clinical outcome and a decrease in bleeding complication.

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Influences of different dose of tirofiban for acute ST elevation myocardial infarction patients underwent percutaneous coronary intervention

Cited by 17 publications

References 32 publications

Improved Cardiac Function and Attenuated Inflammatory Response by Additional Administration of Tirofiban during PCI for ST-Segment Elevation Myocardial Infarction Patients

Improved Cardiac Function and Attenuated Inflammatory Response by Additional Administration of Tirofiban during PCI for ST-Segment Elevation Myocardial Infarction Patients

Comparison of Intracoronary Versus Intravneous Tirofiban in Acute STEMI Patients Undergoing Primary PCI

Clinical efficacy and safety of tirofiban combined with conventional dual antiplatelet therapy in ACS patients undergoing PCI

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