Angiographic and Clinical Outcome in ST-Segment Elevation Myocardial Infarction Patients Receiving an Adjunctive Double Bolus Regimen of Tirofiban for Primary Percutaneous Coronary Intervention

Abstract

rimary percutaneous coronary intervention (PCI) in patients with acute myocardial infraction (AMI) has been shown to be preferable to thrombolytic therapy in terms of patient survival, higher rates of patency in the infarcted arteries, and lower rates of reinfarction and stroke. 1,2 These benefits of PCI can be further enhanced by administration of platelet glycoprotein IIb/IIIa inhibitors abciximab 3-7 or eptifibatide. 8,9 Tirofiban 10 stands out as a potentially useful adjunct to PCI because it is a small non-peptide molecule, somewhat similar to eptifibatide, and does not elicit an adverse immune reaction. Compared with abciximab, its advantages as an adjunct therapy for PCI are lower cost and no overt bleeding complications. 11 Results from studies of the efficacy of adjunctive tirofiban in patients undergoing PCI have been inconsistent. [12][13][14][15][16][17][18][19][20][21][22][23] Some have shown beneficial angiographic and clinical outcomes, 20,22 whereas others show either no benefit 16 or modest initial clinical improvements, unsustained at 30-day follow-up. 13,17 Interpretation of these results is difficult because different dosing regimens were used; for example, tirofiban was administered at a conventional dose (10 g/kg bolus followed by 0.15 g·kg -1 ·min -1 for 18-36 h) in some studies [12][13][14][15]17,[21][22][23] and in others 16,[18][19][20][21] at a high dose (20-25 g/kg bolus followed 0.15 g·kg -1 ·min -1 for 18-24 h). The conventional dose of tirofiban may not achieve adequate platelet aggregation inhibition compared with abciximab. 14,15,24 Timing of the administration of tirofiban before PCI also varied, 12-23 and patients with different clinical scenarios of acute coronary syndrome were studied. These factors are all likely to influence the results and so it remains unclear what the optimal regimen of adjunctive tirofiban therapy would be for PCI in various patient populations. This study was undertaken to examine the angiographic and clinical outcomes in patients with ST-segment elevation AMI (STEMI) undergoing PCI with a double bolus regimen of tirofiban therapy. Methods PatientsBetween August 2000 and December 2001 we prospectively enrolled 217 patients with AMI with ST-segment elevation 0.1 mV in 2 or more contiguous leads on electrocardiogram (ECG) who were candidates for PCI within 12 h of onset of symptoms or within 18 h of onset of symptoms if cardiogenic shock occurred. Patients were excluded from the study if any of the following were present: bleeding diathesis, neoplasm, recent stroke, uncontrolled hyperten- Angiographic and Clinical Outcome in ST-Segment Elevation Myocardial Infarction Patients Receiving an Adjunctive Double Bolus Regimen of Tirofiban for Primary Percutaneous Coronary InterventionShyh-Ming Chen, MD; Yuan-Kai Hsieh, MD; Gary Bih-Fang Guo, MD; Chi-Yan Fang, MD; Hon-Kan Yip, MD; Chiung-Jen Wu, MD; Morgan Fu, MD Background Because of different dosages, the efficacy of adjunctive tirofiban therapy for primary percutaneous coronary intervention (PCI) is current...

Effects of Upstream Administration of Tirofiban Before Percutaneous Coronary Intervention on Spontaneous Reperfusion and Clinical Outcomes in Acute ST-Segment Elevation Myocardial Infarction

“…28 However, significantly better clinical outcomes were not observed in patients administered high doses of tirofiban compared with those in patients administered the conventional dose during short-term and long-term follow-up. 29,30 Furthermore, patients administered a higher dose of tirofiban likely experienced a greater level of platelet inhibition and improved incidence of SR with less myocardial damage and its sequelae. However, due to its questionable benefits and potential risk of increasing bleeding events, it remains unclear whether a higher dose tirofiban therapeutic strategy translates into better clinical benefits.…”

Effect of Intracoronary Tirofiban in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndrome

“…17 In a more recent study of ST-segment elevation ACS, a double-bolus intravenous regimen of tirofiban did not demonstrate significant angiographic or clinical outcomes in patients undergoing PCI. 18 The 30-day ventricular function and cardiac events following primary PCI are determined by a number of factors, such as the size of the infarct, the status of coronary reperfusion, the use of medications, and presence of serum inflammatory factors such as interleukin-10. 1,2,19 In the present study, there were no significant differences between the study and the control groups in the baseline patient characteristics, plasma levels of CK-MB and cTnT, the time interval from onset of chest pain to PCI or the use of medications.…”

Shock Index on Admission Is Associated with Coronary Slow/No Reflow in Patients with Acute Myocardial Infarction Undergoing Emergent Percutaneous Coronary Intervention

“…The use of tirofiban was not an independent indicator for slow/no reflow, which significantly improves the initial TIMI. The effects of preoperative treatment with tirofiban on the prognosis of acute coronary syndrome (ACS) patients were extensively investigated in the past two decades, but the results were inconsistent [15, 26]. Skyschally et al reported that distal coronary embolization was associated with severe regional contractile dysfunction in animal model [27]; we also found that the value of LVEF after PCI was remarkably lower in patients with slow/no reflow than that in normal reflow.…”