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

Abstract

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.