Upstream tirofiban reduces reperfusion cardiac arrhythmias in patients of acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention

Hsin, Ho-Tsung; Wu, Ching-Fen; Liao, Pen-Chih; Lin, Pi-Chi; Chen, Liang-Yü

doi:10.1016/j.ijcard.2010.10.088

Cited by 3 publications

(1 citation statement)

References 18 publications

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“…Primary percutaneous coronary intervention (PCI) is the preferred method for early restoration of blood flow in the infarct-related vessel in patients with ST-segment elevation myocardial infarction (STEMI) (1-3), and adjunctive anti-platelet therapy is found to be associated with clinical outcomes following primary PCI (4, 5). In addition to the standard dual antiplatelet therapy consisting of aspirin and clopidogrel, further measures to inhibit platelet aggregation, such as addition of a glycoprotein IIb/IIIa inhibitor (GPI), have been shown to reduce thrombotic complications and the composite incidence of death, myocardial infarction, and the need for target vessel revascularization after PCI (6).…”

Section: Introductionmentioning

confidence: 99%

The effects of tirofiban infusion on clinical and angiographic outcomes of patients with STEMI undergoing primary PCI

Kaymaz¹,

Keleş²,

Özdemir³

et al. 2015

Anatol J Cardiol

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Objective:The present study was designed to determine the effects of tirofiban (Tiro) infusion on angiographic measures, ST-segment resolution, and clinical outcomes in patients with STEMI undergoing PCI. Glycoprotein (GP) IIb/IIIa inhibitors are beneficial in ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI), while the most effective timing of administration is still under investigation.Methods:A total of 1242 patients (83.0% males, mean (standard deviation; SD) age: 54.7 (10.9) years) with STEMI who underwent primary PCI were included in this retrospective non-randomized study in four groups, composed of no tirofiban infusion [Tiro (-); n=248], tirofiban infusion before PCI (pre-Tiro; n=720), tirofiban infusion during PCI (peri-Tiro; n=50), and tirofiban infusion after PCI (post-Tiro; n=224). In all Tiro (+) patients, bolus administration of Tiro (10 pg/kg) was followed by infusion (0.15 pg/kg/min) for a mean (SD) duration of 22.4±6.8 hours.Results:The pre-PCI Tiro group was associated with the highest percentage of patients with TIMI 3 flow (99.4%; p<0.001), the lowest corrected TIMI frame count [21(18-23.4); p<0.001], the highest percentage of patients with >75% ST-segment resolution (78.1%; p<0.001), and the lowest rate of in-hospital sudden cardiac death and in-hospital all-cause mortality (3.2%, p<0.05, 3.3%, p=0.01). Major bleeding was reported in 18 (1.8%) patients who received tirofiban.Conclusion:Use of standard-dose bolus tirofiban in addition to aspirin, high-dose clopidogrel, and unfractionated heparin prior to primary PCI significantly improves myocardial reperfusion, ST-segment resolution, in-hospital mortality rate, and in-hospital sudden cardiac death in patients with STEMI with no increased risk of major bleeding.

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Section: Introductionmentioning

confidence: 99%

The effects of tirofiban infusion on clinical and angiographic outcomes of patients with STEMI undergoing primary PCI

Kaymaz¹,

Keleş²,

Özdemir³

et al. 2015

Anatol J Cardiol

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Safety and efficacy of early administration of tirofiban in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: a meta-analysis

Liu,

Su,

2014

Chinese Medical Journal

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Background Tirofiban has been widely used as an adjunctive pharmacologic agent for revascularization in patients undergoing percutaneous coronary intervention, and the outcomes appear attractive. However, the potential benefits from early administration of tirofiban in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) remain unclear. Methods We conducted a search in MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials up to September 2012 without language restriction. A total of eight randomized trials (n=1 577 patients) comparing early (emergency department or ambulance) versus late (catheterization laboratory) administration of tirofiban in STEMI patients undergoing PPCI were included in this meta-analysis. Risk ratio (RR) was computed from individual studies and pooled with random- or fixed-effect models. Results There were no differences in post-procedural Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 and Corrected TIMI Frame Count (RR=1.02, 95% confidence interval (CI): 0.99–1.05, P=0.18; weighted mean difference (WMD)=-0.93, 95% CI: -5.37–3.52, P=0.68, respectively) between the two groups. Similarly, there were no significant differences in the incidence of 30-day mortality (RR=1.69, 95% CI: 0.69–4.13, P=0.25) and re-myocardial infarction (RR=0.71, 95% CI: 0.21–2.35, P=0.57) between early and late administration of tirofiban. As to the safety end points, no significant difference was observed in hospital minor bleeding (RR=1.08, 95% CI: 0.54–2.14, P=0.83) and hospital and 30-day major bleeding between the two groups (RR=0.98, 95% CI: 0.46–2.10, P=0.96; RR=1.32, 95% CI: 0.59–2.97, P=0.49, respectively). Conclusions Early administration of tirofiban in patients undergoing PPCI for STEMI was safe, but no beneficial effects on post-procedural angiographic or clinical outcomes could be identified as compared with late administration. Besides the negative finding, more high-quality randomized clinical trials are still needed to explore the efficacy of adequate, earlier administration of tirofiban in patients undergoing PPCI.

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Comparison of Intracoronary Tirofiban And Intravenous Tirofiban for Major Adverse Cardiac Events and Cerebrovascular Accident

Bukhari,

Rana,

Mirza

et al. 2023

PJHS

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Major Adverse Cardiovascular Events (MACE) and and Cerebrovascular Accidents (CVA) have become primary areas of interest due to the ongoing focal research in cardiovascular diseases. Objective: To assess the frequency of major adverse cardiac events and cerebrovascular accidents for intracoronary tirofiban and intravenous tirofiban. Methods: It was a comparative study conducted at the Punjab Institute of Cardiology, Lahore from March 2019 to March 2020. A total of 250 patients of both genders, aged between 20 to 65 years were enrolled in this study who had STEMI and have high thrombus burden or TIMI flow grade < 3 during primary PCI. They were divided into two groups namely intracoronary tirofiban group and intravenous tirofiban. The impact of intracoronary tirofiban versus intravenous tirofiban outcomes were assessed. Results: Statistically insignificant difference in MACE (myocardial infarction, cerebrovascular accident & revascularization) between intracoronary & intravenous tirofiban groups was noted. The frequency distribution for cerebrovascular accidents (CVA) showed that haemorrhage was found similar in both groups. Ischemic stroke, in patients of the intracoronary tirofiban group compared with intravenous tirofiban group, was 1 (0.8%) vs 3 (2.4%) with p-value 0.348 respectively. Reversible ischemic neurological deficit (RIND) was found in 3 (2.4%) in the intracoronary and 4 (3.2%) in the intravenous group. Transient ischemic attack (TIA) found in the intracoronary was 8(6.4%) whereas in the intravenous group was 9 (7.2%). Conclusions: The results of our study make us conclude that tirofiban when given intracoronary or intravenous does not show any significant difference for major adverse cardiac events and cerebrovascular accidents.

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Upstream tirofiban reduces reperfusion cardiac arrhythmias in patients of acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention

Cited by 3 publications

References 18 publications

The effects of tirofiban infusion on clinical and angiographic outcomes of patients with STEMI undergoing primary PCI

The effects of tirofiban infusion on clinical and angiographic outcomes of patients with STEMI undergoing primary PCI

Safety and efficacy of early administration of tirofiban in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: a meta-analysis

Comparison of Intracoronary Tirofiban And Intravenous Tirofiban for Major Adverse Cardiac Events and Cerebrovascular Accident

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