Key result
Intracoronary tirofiban following aspiration thrombectomy significantly decreased median infarct size at 30 days compared to control (15.451 g vs 43.828 g; P=0.002) in large anterior STEMI patients.
Why the study?
Myocardial recovery after primary PCI is often suboptimal despite TIMI 3 flow, partly due to thrombus embolization that impairs microvascular reperfusion and increases infarct size.
Does intracoronary tirofiban following aspiration thrombectomy reduce infarct size in patients with large anterior STEMI undergoing primary PCI?
RCT (n=100)
randomized
Does intracoronary tirofiban following aspiration thrombectomy reduce infarct size in patients with large anterior STEMI undergoing primary PCI?
Intracoronary tirofiban delivered locally following aspiration thrombectomy significantly reduces infarct size at 30 days in patients with large anterior STEMI.
Answers are grounded in this paper and cite their sources.
Supports adjunctive intracoronary tirofiban post-thrombectomy to limit infarct size in large anterior STEMI; extends evidence for targeted GP IIb/IIIa delivery in primary PCI.
BACKGROUND: Myocardial recovery following primary percutaneous coronary intervention is often suboptimal despite of restoration of thrombolysis in myocardial infarction (TIMI) 3 flow, in part due to thrombus embolization which results in impairing microvascular reperfusion besides increasing infarct size. The purpose of the present study was to estimate the effect of aspiration thrombectomy followed by intracoronary delivery of tirofiban on decreasing the infarct size utilizing cardiac MRI (cMR) in large anterior ST-segment elevation myocardial infarction (STEMI) patients. PATIENTS: A prospective randomized controlled study of 100 patients with large anterior STEMI were randomized to (Study group) using intracoronary tirofiban (intracoronary) and (control group) without intocoronary tirofiban. A 6 F thrombus aspiration catheter was used in all patients. Tirofiban was injected locally at the place of the highly thrombus burden through the aspiration device after flushing the aspiration device well. RESULTS: Patients of intracoronary tirofiban group compared with control group had a significant difference in decreasing the infarct size at 30 days [median, 15.451 g - interquartile range (IQR), 17.404 gm - n = 50] vs (median, 43.828 g - IQR, 49.599 g - n = 50) P value = 0.002. CONCLUSION: In patients early presented with large anterior STEMI, infarct size at 30 days was significantly decreased by intracoronary tirofiban delivered to the infarct lesion site followed aspiration thrombectomy.
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Basuoni et al. (2019) conducted an RCT in Large anterior ST-segment elevation myocardial infarction (STEMI) (n=100). Intracoronary tirofiban following aspiration thrombectomy vs. Aspiration thrombectomy without intracoronary tirofiban was evaluated on Infarct size at 30 days (p=0.002). Intracoronary tirofiban following aspiration thrombectomy significantly decreased median infarct size at 30 days compared to control (15.451 g vs 43.828 g; P=0.002) in large anterior STEMI patients.
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