What is the clinical evidence from this study?

Study design: RCT. Population: Adults (mean age ~58 years) with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) with TIMI flow grade < 3 after vessel reopening (n=60). Intervention: Intracoronary tirofiban vs. Intracoronary 0.9% saline placebo. Primary outcome: Coronary artery blood flow post PCI assessed by TIMI flow grade and incidence of no-reflow phenomenon (NRP) (P=0.007, p=0.007).

What question did this study set out to answer?

This study aims to evaluate the effectiveness of intracoronary tirofiban in reducing the incidence of no-reflow after successful recanalization in STEMI patients.

March 3, 2026Open Access

Assessment of No-Reflow in Patients With STEMI After Intracoronary Tirofiban After Opening of the Vessel

Q: What are the key findings of this study?

Intracoronary tirofiban 25 µg/kg reduced no-reflow phenomenon from 53.33% to 20% and increased TIMI 3 flow from 46.67% to 80% versus placebo in STEMI patients after PCI.

Q: What question did this study set out to answer?

This study aims to evaluate the effectiveness of intracoronary tirofiban in reducing the incidence of no-reflow after successful recanalization in STEMI patients.

Key Result

Intracoronary tirofiban 25 µg/kg reduced no-reflow phenomenon from 53.33% to 20% and increased TIMI 3 flow from 46.67% to 80% versus placebo in STEMI patients after PCI.

Key Points

This study aims to evaluate the effectiveness of intracoronary tirofiban in reducing the incidence of no-reflow after successful recanalization in STEMI patients.
Randomized controlled double-blind study involving 60 STEMI cases
Participants received either intracoronary tirofiban or saline placebo post-PCI
TIMI flow grade and incidence of no-reflow were measured
ECG ST-T normalization and adverse effects were recorded
Tirofiban group had 80% achieving TIMI 3 flow compared to 46.67% in controls (P = 0.007)
No-reflow occurred in 20% of tirofiban cases versus 53.33% in controls (P = 0.007)
Minor bleeding complications were higher in the tirofiban group (26.67% vs 3.33%, P = 0.026)
Total in-hospital major adverse cardiac events were 3.33% with tirofiban compared to 30% in controls (P = 0.012)

Study Design

Type

RCT (n=60)

Blinding

Double-blind

Randomization

Stratified random allocation using online randomization program with allocation concealment by opaque envelopes

Multicenter

Structured PICO

Does intracoronary tirofiban improve coronary blood flow and reduce the no-reflow phenomenon in STEMI patients with TIMI flow <3 after primary PCI?

Population

60 adults (aged ≥18 years) with STEMI presenting at a single center in Egypt, who had TIMI flow grade <3 following successful primary percutaneous coronary intervention (PCI). Mean age ~58 years, ~73% male. Key exclusions: prior thrombolytic therapy within 24 h, known malignancies, thrombocytopenia, end-stage liver disease, cardiogenic shock, renal failure with eGFR <30 mL/min.

Intervention

Intracoronary tirofiban 25 µg/kg as a single bolus, added to standard pre-procedural therapy (aspirin 300 mg oral, IV heparin 70 U/kg, and ticagrelor 180 mg oral loading dose).

Comparator

Intracoronary 0.9% saline solution as matching placebo, added to standard pre-procedural therapy (aspirin 300 mg oral, IV heparin 70 U/kg, and ticagrelor 180 mg oral loading dose).

Outcome

Coronary artery blood flow evaluated by TIMI flow grade and frame count pre- and post-treatment (within 15 min).surrogate

Main Result

Effect estimate: P=0.007

Absolute Event Rate: 80% vs 46.67%

p-value: p=0.007

Limitations

Single-center study with small sample size
Short follow-up duration (30 days) limits long-term outcome assessment
TIMI flow grading and frame count have low specificity for microvascular obstruction
No direct measurement of microvascular function or infarct size by cardiac MRI
Not powered to detect differences in MACE
IC tirofiban not guideline-endorsed due to limited large trials and heterogeneous study designs

Abstract

Background: No-reflow phenomenon (NRP) following primary percutaneous coronary intervention (PPCI) remains a critical determinant of adverse outcomes in ST-segment elevation myocardial infarction (STEMI) cases despite successful epicardial recanalization. The core purpose of this study was to establish the value of intracoronary (IC) tirofiban, delivered via the IC route, in mitigating the occurrence of NRP for STEMI cases subsequent to successful vessel reopening. Methods: This randomized controlled double-blind study enrolled 60 STEMI cases. Following successful PCI, cases with thrombolysis in myocardial infarction (TIMI) flow grade less than 3 were randomized to receive either IC tirofiban (25 mg/kg) or saline 0.9% as placebo, in addition to standard pre-procedural therapy with aspirin, heparin, and ticagrelor. TIMI flow grade and incidence of NRP were evaluated. Additionally, ST-T normalization in electrocardiogram (ECG) was assessed. Bleeding complications and major adverse cardiac events (MACEs) were recorded during hospitalization and at 30-day follow-up. Results: The tirofiban group demonstrated notably superior coronary flow restoration with 80% achieving TIMI 3 flow versus 46.67% in controls (P = 0.007). NRP occurred in 20% of tirofiban cases compared to 53.33% in controls (P = 0.007). Minor bleeding complications increased in the tirofiban group (26.67% versus 3.33%, P = 0.026), while major bleeding remained absent in both groups. Total in-hospital MACEs were notably reduced with tirofiban treatment compared to controls (3.33% versus 30%, P = 0.012). Conclusions: In STEMI cases following PPCI, IC tirofiban administration effectively reduces NRP, improves coronary flow restoration, and reduces MACE despite increased minor bleeding risk.

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Cite This Study

Hammad et al. (Sun,) conducted a rct in Adults (mean age ~58 years) with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) with TIMI flow grade < 3 after vessel reopening (n=60). Intracoronary tirofiban vs. Intracoronary 0.9% saline placebo was evaluated on Coronary artery blood flow post PCI assessed by TIMI flow grade and incidence of no-reflow phenomenon (NRP) (P=0.007, p=0.007). Intracoronary tirofiban 25 µg/kg reduced no-reflow phenomenon from 53.33% to 20% and increased TIMI 3 flow from 46.67% to 80% versus placebo in STEMI patients after PCI.

synapsesocial.com/papers/69a67e0ef353c071a6f09ec7 https://doi.org/https://doi.org/10.14740/cr2180

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