Impact of Early Tirofiban Administration on Myocardial Salvage in Patients with Acute Myocardial Infarction Undergoing Infarct-Related Artery Stenting

Abstract

Background/Aims: The timing of GpIIb/IIIa inhibitor administration may be important in achieving early epicardial and myocardial reperfusion. We evaluated the effect of early tirofiban on myocardial salvage and cardiovascular outcome in patients with acute myocardial infarction (AMI) undergoing infarct-related artery stenting. Methods: Patients (n = 66) with a first AMI presenting <6 h from onset of symptoms were randomized to either early administration of tirofiban in the emergency room (n = 32) or later administration in the catheterization laboratory (n = 34) (tirofiban bolus dose of 10 µg/kg, followed by 0.15 µg/kg for 24 h). The primary end-point was the degree of myocardial salvage, determined by means of serial scintigraphic studies with technetium-99m sestamibi. Thirty-day major adverse cardiac events were also assessed. Results: There were no significant differences in patient characteristics or in their presentation. The mean door-to-balloon time was similar in both groups (43 ± 12 and 53 ± 9 min, p = 0.08). The early and late treatment groups received tirofiban 18 ± 4 and 52 ± 10 min after admission, respectively. Angiographic analysis revealed a higher initial frequency of TIMI grade 3 flow in the early group (31% vs. 12%, p = 0.04). Procedural success was achieved in all patients. Myocardial risk area were comparable between early and late treatment groups (35.6 ± 12.2% vs. 39.3 ± 14.0%, p = 0.6). Scintigraphic outcomes demonstrated a significant reduction in the final infarction size (11.8 ± 5.2% vs. 22.4 ± 6.2%, p = 0.01), and improvement in salvage index (0.68 ± 0.22 vs. 0.44 ± 0.18, p = 0.003) in favor of the early tirofiban group. The thirty-day composite end-point of death, recurrent MI or rehospitalization also favored the early group (6% early, 15% late, p = 0.06). Conclusion: Early tirofiban administration enhanced the degree of myocardial salvage and clinical outcome in patients with AMI undergoing infarct-related artery stenting.

Effect of intracoronary tirofiban on platelet alpha-granule membrane protein and myocardial perfusion level during emergency percutaneous coronary intervention

“…Previous studies have shown that the application of platelet glycoprotein IIb/IIIa receptor antagonists before primary PCI obviously improves the prognosis of patients (Cutlip et al, 2003;Lee et al, 2003;Zeymer et al, 2005;Emre et al, 2006;Gabriel et al, 2006;Gibson et al, 2006;Rakowski et al, 2007;De Luca et al, 2008). This finding is consistent with the results of our research.…”

Part 9: Acute Coronary Syndromes

“…This result was supported by many studies which consistently reported better outcomes with upstream or early use of glycoprotein IIb/IIIa inhibitor compared with deferred treatment or other strategies (LOE 1 [452][453][454][455][456][457][458][459][460][461][462][463][464][465][466][467] ; LOE 2 468 -473 ; LOE 3 474 ; LOE 4 [475][476][477][478] ; LOE 5 479 ).…”

Impact of upstream high bolus dose tirofiban on left ventricular systolic function in patients with acute anterior myocardial infarction treated by primary coronary intervention

“…These baseline characteristics were also statistically non-significant in the studies done by Tuba et al (2006) 25 who compared the high bolus dose regimen with the standard regimen. Also, these factors were statistically non-significant in the study done by Emre et al (2006) 26 who evaluated the effect of early tirofiban on myocardial salvage and cardiovascular outcome in patients with acute myocardial infarction (AMI) undergoing infarct-related artery stenting. As the success rate is inversely correlated to the duration of symptoms, also is inversely correlated to the time to treatment, 27 so, in this study the door to needle time and door to balloon time were tried to be nearly in the same range in all groups (door to needle time was around 30 min and door to balloon time was around 90 min in all study groups) in order not to affect the angiographic results.…”