Short-term effect of upstream administration in comparison to deferred injection of tirofiban on patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

Abstract

BACKGROUND:

High bolus dose tirofiban has been demonstrated to provide greater inhibition of platelet aggregation, but the most appropriate timing of its administration remains unknown.

OBJECTIVES:

To evaluate the efficacy of upstream vs. deferred administration of tirofiban in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI) on clinical outcomes.

METHODS:

The 660 patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention were divided into upstream (n=330, administration of tirofiban to all patients in emergency room) and deferred groups (n=330, treatment of patients with large thrombus burden or no-reflow phenomenon in cardiac catheterization laboratory during PCI). The primary end-points were death, nonfatal myocardial infarction (MI), stent thrombosis (ST), revascularization of targeted vessels (TVR) or major adverse cardiac events (MACE) at 1 month and 6 months following PCI, with safety end-point at 7 days.

RESULTS:

Compared with that of the deferred group, there was a significant increase of left ventricular ejection fraction (LVEF) in the upstream group within 7 days (55.5 ± 6.6% vs. 54.6 ± 7.9%, P=0.011). The rates of 7-day and 1-month MACE in the upstream group were lower than those in the deferred group (1.5% vs. 4.2%, 3.3% vs. 7.0%, P=0.037 and 0.034, respectively). However, there were higher tendencies for major and minor bleedings in the upstream group (1.8% vs. 0.9%, 2.7% vs. 1.5%, P=0.315 and 0.280, respectively).

CONCLUSION:

To the Chinese patients with acute myocardial infarction undergoing primary PCI, upstream administration of tirofiban was slightly superior to deferred injection for short-term clinical outcomes.

• Authors: Zhi Jia, Mu Guo, Yun-Qiang Zhang, Hai-Qing Liang, Yu Song
• Journal: Journal of interventional cardiology (J Interv Cardiol) Vol. 26 Issue 4 Pg. 332-9 (Aug 2013) ISSN: 1540-8183 [Electronic] United States
• PMID: 23844823 (Publication Type: Comparative Study, Journal Article)
• Copyright: © 2013, Wiley Periodicals, Inc.

Chemical References

• Platelet Aggregation Inhibitors
• Tyrosine
• Tirofiban

Topics

• Aged
• Coronary Angiography
• Electrocardiography
• Female
• Humans
• Injections
• Male
• Middle Aged
• Myocardial Infarction (diagnosis, diagnostic imaging, drug therapy)
• Percutaneous Coronary Intervention
• Platelet Aggregation Inhibitors (administration & dosage)
• Stroke Volume
• Tirofiban
• Tyrosine (administration & dosage, analogs & derivatives)
• Ventricular Function, Left