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

Abstract

We assessed the effects of upstream administration of the glycoprotein IIb/IIIa inhibitor tirofiban before percutaneous coronary intervention (PCI) on spontaneous reperfusion (SR) of infarct-related artery (IRA) and the clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). The incidence of SR of the IRA was significantly higher in the tirofiban group than in the no-tirofiban group (141 [36.5%] vs 21 [17.2%], P < .001). By multivariate logistic regression analysis, use of tirofiban (odds ratio 2.32, 95% confidence interval 1.25-4.31, P = .008) independently predicted the occurrence of SR. Kaplan-Meier survival analysis demonstrated that major adverse cardiovascular event-free survival was significantly higher in patients treated with tirofiban than in patients without tirofiban at 30-day (log rank = 11.65, P = .001) and 90-day follow-up (log rank = 16.79, P < .001). Upstream administration of tirofiban is significantly associated with increased SR of the IRA and favorable clinical prognosis in patients undergoing PCI for STEMI.

Role of tirofiban with dual antiplatelet therapy in patients with STEMI undergoing primary PCI

“…According to these studies, the 2012 ESC guideline defined that there is no definitive answer regarding the current role of the routine use of GP IIb/IIIa inhibitors in primary PCI in the era of potent DAPT, particularly when prasugrel or ticagrelor is used (5). On the other hand, recent studies (6, 7) of tirofiban with DAPT in STEMI support the findings of Kaymaz et al (1) Tirofiban administered with primary PCI following the administration of 600 mg clopidogrel improved the primary efficacy outcome at 30-day and 1-year follow-up without an increase in major bleeding. Zhu et al (7) demonstrated that the upstream use of tirofiban is significantly associated with an increased incidence of spontaneous reperfusion and a decreased incidence of MACE at 30-day as well as 90-day follow-up in patients treated with primary PCI for STEMI.…”

“…On the other hand, recent studies (6, 7) of tirofiban with DAPT in STEMI support the findings of Kaymaz et al (1) Tirofiban administered with primary PCI following the administration of 600 mg clopidogrel improved the primary efficacy outcome at 30-day and 1-year follow-up without an increase in major bleeding. Zhu et al (7) demonstrated that the upstream use of tirofiban is significantly associated with an increased incidence of spontaneous reperfusion and a decreased incidence of MACE at 30-day as well as 90-day follow-up in patients treated with primary PCI for STEMI. I appreciate the authors for highlighting the use of tirofiban with DAPT in STEMI patients.…”

“…There are some issues that need to be clarified to obtain more data from the study. The intracoronary use of GP IIb/IIIa inhibitors has been tested in several small studies, and it is associated with some benefits (7). Did you apply intracoronary tirofiban in the peri-Tiro group in any patients?…”

Intracoronary administration of tirofiban during percutaneous coronary intervention facilitates patients with acute coronary syndrome

“…However, expansion of balloon and stimulating effect of metal stents can cause endothelial injury, platelet activation and aggregation, adhesion, and lead to acute vascular occlusion and coronary artery embolism formation after PCI operative. Therefore, antiplatelet therapy was a very important part of PCI therapy [ 3 ].…”