Key result
Early administration of bolus tirofiban in the emergency ward resulted in a non-significant increase in initial TIMI grade 3 flow compared to control (21.4% vs 10%, OR 0.407, p=0.06).
Why the study?
Does early administration of tirofiban improve initial TIMI grade 3 flow in patients with STEMI prior to primary PCI?
RCT (n=140)
Single-blind
Block randomization
Does early administration of tirofiban improve initial TIMI grade 3 flow in patients with STEMI prior to primary PCI?
Odds Ratio: 0.407 (95% CI 0.155–1.072)
Absolute Event Rate: 21.4% vs 10%
p-value: p=0.06
Early administration of bolus tirofiban in the emergency department prior to primary PCI for STEMI did not significantly improve initial TIMI grade 3 flow compared to control.
Early tirofiban does not significantly improve pre-PCI TIMI 3 flow in STEMI; leaves open whether larger trials or refined protocols would alter outcomes.
BACKGROUND: Before primary percutaneous coronary intervention (PCI) in patients with ST elevation myocardial infarction (STEMI), it is not clear whether a routine early administration of glycoprotein IIb/IIIa inhibitors in the emergency ward is beneficial or their administration in selected cases in the catheterization laboratory. OBJECTIVES: The present randomized clinical trial sought to investigate whether an earlier administration of Tirofiban could exert any impact on TIMI grade 3 flows and ST resolution in the electrocardiography of patients with STEMI before primary PCI. MATERIALS AND METHODS: Patients with STEMI within twelve hours of symptom commencement were included if primary PCI was planned to be performed within ninety minutes of admission and excluded if they had contraindications for Tirofiban. Seventy patients were randomized to receive 25 μg/kg of bolus Tirofiban early in the emergency ward (the early Tirofiban group) in three minutes and 70 did not receive Tirofiban (the control group). The primary endpoint of the study was a Thrombolysis in Myocardial Infarction (TIMI) grade 3 flows on the initial angiogram. The study is registered as IRCT201105126463N1 in: www.irct.ir. RESULTS: The study population had a mean age of 57.17 ± 10.09 years and included 79.3 % males. TIMI grade 3 flow was seen in 15 (21.4 %) patients of the Tirofiban group and 7 (10 %) of the control group (P = 0.06, odds ratio = 0.407, and 95 % confidence interval = 0.155-1.072). Complete ST resolution was seen in 30 (42.9 %) patients of the Tirofiban group and 34 (48.6 %) of the control group (P = 0.5). CONCLUSION: Although TIMI grade 3 flows trended to be higher in the patients who received early Tirofiban in the emergency ward, the difference did not constitute statistical significance and possible benefits, therefore, require further clarification.
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Salarifar et al. (2014) conducted an RCT in ST Elevation Myocardial Infarction (STEMI) (n=140). Tirofiban vs. No early Tirofiban (control) was evaluated on TIMI grade 3 flow on the initial angiogram before primary PCI (OR 0.407, 95% CI 0.155-1.072, p=0.06). Early administration of bolus tirofiban in the emergency ward resulted in a non-significant increase in initial TIMI grade 3 flow compared to control (21.4% vs 10%, OR 0.407, p=0.06).
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