Key result
Intracoronary administration of tirofiban significantly increased TIMI grade 3 flow (OR 2.11) and reduced major adverse cardiovascular events (OR 0.46) compared to intravenous administration in patients with acute coronary syndrome undergoing PCI.
Why the study?
Does intracoronary administration of tirofiban improve coronary flow and reduce MACE compared to intravenous administration in ACS patients undergoing PCI?
Meta-Analysis (n=1,027)
Does intracoronary administration of tirofiban improve coronary flow and reduce MACE compared to intravenous administration in ACS patients undergoing PCI?
Intracoronary administration of tirofiban during PCI for ACS improves coronary flow and reduces MACE compared to intravenous administration, without increasing bleeding risk.
IC tirofiban may improve flow and outcomes versus IV in ACS PCI; confirms route-specific benefit in pooled randomized data.
BACKGROUND: Percutaneous coronary intervention (PCI) is known as the most effective treatment for acute coronary syndrome (ACS). However, without proper therapy and patient management, stent thrombosis after PCI may lead to another myocardial infarction. In addition to aspirin and clopidogrel, tirofiban is often used as an antiplatelet therapy in patients with ACS. To date, there has been no comprehensive evaluation of the efficacy and safety of intracoronary (IC) tirofiban administration for ACS patients undergoing PCI compared with intravenous (IV) administration. Therefore, this meta-analysis was conducted to investigate the clinical efficiency and safety of IC versus intravenous (IV) tirofiban in ACS patients undergoing PCI. METHODS: We searched PubMed and Medline for randomized controlled trials (RCTs) comparing IC versus IV administration of tirofiban in ACS patients undergoing PCI. We evaluated the effects of tirofiban on thrombolysis in myocardial infarction (TIMI) grade 3 flow after PCI, TIMI myocardial perfusion grade 3 (TMP grade 3), left ventricular ejection fraction (LVEF), major adverse cardiovascular events (MACE), target vessel revascularization (TVR), death, reinfarction and adverse drug effects (specifically bleeding events). RESULTS: Seven trials involving 1,027 patients were included in this meta-analysis. IC administration of tirofiban significantly increased TIMI grade 3 flow (OR 2.11; 95% CI 1.02 to 4.37; P = 0.04) and TMP grade 3 (OR 2.67; 95% CI 1.09 to 6.49; P = 0.03, I2 = 64%) while reducing MACE (OR 0.46, 95% CI: 0.28 to 0.75; P = 0.002) compared with IV administration of tirofiban. No significant differences were observed in the occurrence of TVR, death, reinfarction and the incidence of bleeding events between the two groups. CONCLUSIONS: This meta-analysis supports the use of IC over IV administration of tirofiban in patients with ACS to improve TIMI flow, TMP flow and MACE. However, there was no statistically significant difference in the risk of bleeding complications between the two groups.
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Tang et al. (2015) conducted a meta-analysis in Acute Coronary Syndrome (ACS) (n=1,027). Intracoronary tirofiban vs. Intravenous tirofiban was evaluated on TIMI grade 3 flow after PCI (OR 2.11, 95% CI 1.02 to 4.37, p=0.04). Intracoronary administration of tirofiban significantly increased TIMI grade 3 flow (OR 2.11) and reduced major adverse cardiovascular events (OR 0.46) compared to intravenous administration in patients with acute coronary syndrome undergoing PCI.
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