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

Background: Glycoprotein IIb/IIIa inhibitor therapy during primary percutaneous coronary intervention (PCI) decreases the incidence of major adverse cardiac events. Aim: To study the impact of high bolus dose tirofiban on left ventricular ejection fraction in patients with acute anterior ST segment elevation MI treated with primary PCI. Patients and methods: Forty patients presenting to Ain Shams University, and specialized hospitals with the diagnosis of acute anterior STEMI were treated with primary PCI. Twenty patients were given conventional intravenous bolus dose tirofiban (10 μg/kg) upstream prior to primary angioplasty and twenty patients were given intravenous high bolus dose tirofiban (25 μg/kg) upstream prior to PCI. In-hospital follow up was done including echocardiography, and serial cardiac enzymes in addition to clinical follow up for MACE and bleeding complications. Results: Successful primary angioplasty was attained in all patients. The LV systolic function was significantly better in the high bolus dose group in comparison to the conventional bolus dose groups (48% vs 41%, P < 0.01). The incidence of recurrent ischemia was statistically non-significant between the two groups (5% vs 25%, P > 0.05). Both regimens were safe and the bleeding complications were minimal and did not differ between the study groups. Conclusion: In patients presenting with acute anterior STEMI and treated with primary PCI, the high bolus dose tirofiban given intravenously upstream prior to PCI seems to be a safe and effective regimen to achieve a better left ventricular ejection fraction in comparison to the conventional bolus dose regimen, without increasing the risk of bleeding.