The effects of tirofiban infusion on clinical and angiographic outcomes of patients with STEMI undergoing primary PCI

Abstract

Objective:The present study was designed to determine the effects of tirofiban (Tiro) infusion on angiographic measures, ST-segment resolution, and clinical outcomes in patients with STEMI undergoing PCI. Glycoprotein (GP) IIb/IIIa inhibitors are beneficial in ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI), while the most effective timing of administration is still under investigation.Methods:A total of 1242 patients (83.0% males, mean (standard deviation; SD) age: 54.7 (10.9) years) with STEMI who underwent primary PCI were included in this retrospective non-randomized study in four groups, composed of no tirofiban infusion [Tiro (-); n=248], tirofiban infusion before PCI (pre-Tiro; n=720), tirofiban infusion during PCI (peri-Tiro; n=50), and tirofiban infusion after PCI (post-Tiro; n=224). In all Tiro (+) patients, bolus administration of Tiro (10 pg/kg) was followed by infusion (0.15 pg/kg/min) for a mean (SD) duration of 22.4±6.8 hours.Results:The pre-PCI Tiro group was associated with the highest percentage of patients with TIMI 3 flow (99.4%; p<0.001), the lowest corrected TIMI frame count [21(18-23.4); p<0.001], the highest percentage of patients with >75% ST-segment resolution (78.1%; p<0.001), and the lowest rate of in-hospital sudden cardiac death and in-hospital all-cause mortality (3.2%, p<0.05, 3.3%, p=0.01). Major bleeding was reported in 18 (1.8%) patients who received tirofiban.Conclusion:Use of standard-dose bolus tirofiban in addition to aspirin, high-dose clopidogrel, and unfractionated heparin prior to primary PCI significantly improves myocardial reperfusion, ST-segment resolution, in-hospital mortality rate, and in-hospital sudden cardiac death in patients with STEMI with no increased risk of major bleeding.

Effect of early tirofiban administration on N‐terminal pro‐B‐type natriuretic peptide level in patients treated with primary percutaneous coronary intervention

“…3 Moreover also in large real word STEMI population tirofiban administration prior to primary PCI showed significant improvement in myocardial reperfusion, ST-segment resolution and in-hospital mortality rate. 19 Interestingly, in our analysis, early tirofiban administration effect on NT-proBNP level post-PCI was independent from baseline NT-proBNP level. Indeed, although baseline NT-proBNP level was related to post-PCI level and baseline NT-proBNP has been correlated to microvascular obstruction after PCI, 20 it has been shown that patients with higher baseline level of NT-proBNP may derive particular clinical benefit from early GPIs treatment.…”

“…Moreover also in large real word STEMI population tirofiban administration prior to primary PCI showed significant improvement in myocardial reperfusion, ST‐segment resolution and in‐hospital mortality rate …”

Efficacy and safety of single high-dose versus double high-dose intracoronary bolus tirofiban in patients with ST-segment elevation myocardial infarction

“…The substantial finding of our study is that, administration of double high-dose intracoronary bolus tirofiban in STEMI patients undergoing primary PCI, in addition to aspirin, heparin, and high-dose clopidogrel, wasassociated with lower 30-day TVR rates without leading to a significant increase in minor or major bleeding.However, it did not significantly affect MACE and all-cause mortality rates. Unlike the trials involved low-dose bolus regimens [6][7][8][9], studies involving the high-dose bolus regimen of tirofiban support its efficacy and safety in patients with STEMI undergoing primary PCI [10][11][12]. To the best of our knowledge, this is the first study in the literature comparing the efficacy and safety of the single highdose versus double high-dose intracoronary bolus tirofiban in patients undergoing primary PCI.…”

“…Tirofiban is a highly selective anda short-acting platelet glycoprotein (GP) IIb/IIIa receptor inhibitor,which inhibits platelet aggregation by blocking the combination of fibrinogen and GP IIb/IIIa and consequently prevents myocardial ischemia caused by coronary thrombosis [4,5]. Regarding tirofiban dosage, unlike the trials of low-dose bolus regimens [6][7][8][9], recent studies involving the high-dose bolus regimen support its efficacy in patients with STEMI undergoing primary PCI [10][11][12]. These results may translate to clinical benefit while not significantly increasing bleeding complications.Not only the optimal doses but also the ideal route of administration of GP IIb/IIIa receptor inhibitors has also been actively investigated [13,14].…”

Effect of Tirofiban on the Outcome During Hospitalization in Patients With Acute Coronary Syndrome an Observational Study

“…Lately, several studies [1][2][3] showed that GPIIb/IIIa inhibitors improve outcome in ACS patients with or without any coronary intervention. However, various studies [4][5][6][7] showed that the adjunctive treatment with tirofiban does not confer any clinical benefit, as compared with placebo or other antiplatelet drugs, such as abciximab and ticagrelor [8]. Thus, controversy still exists in the clinical efficacy of tirofiban on ACS.…”