Effect of intracoronary tirofiban following aspiration thrombectomy on infarct size, in patients with large anterior ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

Abstract

Background Myocardial recovery following primary percutaneous coronary intervention is often suboptimal despite of restoration of thrombolysis in myocardial infarction (TIMI) 3 flow, in part due to thrombus embolization which results in impairing microvascular reperfusion besides increasing infarct size. The purpose of the present study was to estimate the effect of aspiration thrombectomy followed by intracoronary delivery of tirofiban on decreasing the infarct size utilizing cardiac MRI (cMR) in large anterior ST-segment elevation myocardial infarction (STEMI) patients. Patients A prospective randomized controlled study of 100 patients with large anterior STEMI were randomized to (Study group) using intracoronary tirofiban (intracoronary) and (control group) without intocoronary tirofiban. A 6 F thrombus aspiration catheter was used in all patients. Tirofiban was injected locally at the place of the highly thrombus burden through the aspiration device after flushing the aspiration device well. Results Patients of intracoronary tirofiban group compared with control group had a significant difference in decreasing the infarct size at 30 days [median, 15.451 g – interquartile range (IQR), 17.404 gm – n = 50] vs (median, 43.828 g – IQR, 49.599 g – n = 50) P value = 0.002. Conclusion In patients early presented with large anterior STEMI, infarct size at 30 days was significantly decreased by intracoronary tirofiban delivered to the infarct lesion site followed aspiration thrombectomy.

Effects of Intracoronary Pro-urokinase or Tirofiban on Coronary Flow During Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction: A Multi-Center, Placebo-Controlled, Single-Blind, Randomized Clinical Trial

“…Glycoprotein IIb/IIIa inhibitors can prevent platelet aggregation and reduce thrombotic events in patients with acute coronary syndrome ( 34 ). Randomized clinical trials have suggested that intracoronary administration of tirofiban to achieve a high local concentration of the drug can reverse no-flow phenomena and attenuate microvascular obstruction in patients with STEMI undergoing primary PCI ( 19 , 35 – 37 ). Our finding that myocardial reperfusion is improved by intracoronary infusion of tirofiban during primary PCI for acute STEMI is consistent with the above studies and with numerous other investigations evaluating the effects of intracoronary administration of glycoprotein IIb/IIIa inhibitors during PCI ( 14 – 19 ).…”

Intracoronary pharmacological therapy versus aspiration thrombectomy in STEMI (IPAT-STEMI): A systematic review and meta-analysis of randomized trials

“…The left anterior descending (LAD) artery was the infarct-related artery in 32% to 80% of patients in six studies [ 78 , 80 – 82 , 85 , 88 ]. Five studies enrolled patients with anterior STEMI only ( Table 2 ) [ 79 , 83 , 84 , 86 , 87 ].…”

“…Door-to-balloon time ranged from 17.8 to 120 minutes. Radial access during coronary angiography was used in four studies [ 77 , 80 , 84 , 86 ], femoral in two [ 78 , 87 ], and the access approach was not stated in the remaining ones. As a result of identifying various pharmacological interventions, the studies were divided into three groups; thrombolytics (Group 1), GPI (Group 2), and GPI plus AT (Group 3).…”

“…The main comparisons included thrombolytics versus AT, GPI versus AT, and GPI plus AT versus AT. Four studies administered thrombolytic agents (prourokinase, urokinase) [ 77 – 80 ], three investigated GPI (abciximab, eptifibatide, tirofiban) [ 81 – 83 ], and five combined GPI with AT [ 84 – 88 ]. The latter group has subgroups from two studies included in Group 2 [ 81 , 83 ] Two [ 78 , 79 ] of four studies in Group 1 have used thrombolytic agent plus AT, and one study [ 79 ] used intracoronary urokinase with tirofiban.…”

“…It is known that the process of left ventricle improvement is slow and may take up to six months [ 86 ]. Similarly, early evaluation of the infarct size after myocardial reperfusion (i.e., 2–7 days), which is a predictor of left ventricular remodelling [ 103 , 104 ], may be misleading due to the underlying edema that would behave as a nonviable myocardium [ 84 ]. Unexpectedly, in the present meta-analysis, the pooled infarct size results of two studies in Group 3 [ 81 , 86 ] significantly improved within seven days of PCI (mean difference = -2.97, 95% CI: -5.47 to -0.47) but not at 30-day follow-up in another two studies [ 83 , 84 ] (mean difference = -7.36, 95% CI: -15.33 to 0.6) (S3 Fig in S1 File ).…”