Key result
High-dose tirofiban during primary PCI for STEMI resulted in higher rates of corrected TIMI frame count, TIMI grade 3 flow, and ST-segment resolution >50% compared to lower doses and control.
Why the study?
Tirofiban is commonly prescribed during primary percutaneous coronary intervention for STEMI, but the impact of a high bolus dose on clinical outcomes needed evaluation.
Does a high bolus dose of tirofiban improve clinical outcomes and myocardial reperfusion compared to lower doses or control in STEMI patients undergoing primary PCI?
RCT (n=272)
random number table
No
Does a high bolus dose of tirofiban improve clinical outcomes and myocardial reperfusion compared to lower doses or control in STEMI patients undergoing primary PCI?
While high-dose tirofiban improves myocardial reperfusion and reduces short-term MACE in STEMI patients undergoing primary PCI, it significantly increases the risk of hemorrhage and thrombocytopenia, suggesting a medium dose may offer a better safety-efficacy balance.
High-dose tirofiban was associated with lower 30-day MACE in STEMI PCI; leaves open need for randomized trials before practice change.
Introduction: When patients suffering from acute ST-elevation myocardial infarction (STEMI) undergo for percutaneous coronary intervention, tirofiban is mostly prescribed. Objective: In this study, patients undergoing for primary percutaneous coronary intervention for ST-segment elevation myocardial infarction were evaluated to determine the impact of a high bolus dose (HBD) of tirofiban on clinical outcomes. Methods: This study included 272 acute STEMI patients aged less than 79 years, admitted to the Hayatabad Medical Complex hospital, Peshawar from April 2021 to February 2022. According to the random number table, these patients were divided into four groups: the control group (n= 65), low-dose group (n=69), medium-dose group (n=71) and high-dose group (n=67). Results: After percutaneous coronary intervention, the high-dose group experienced higher rates of corrected TIMI frame count (CTFC), Thrombolysis In Myocardial Infarction (TIMI) grade 3, and total frequency of ST-segment resolution greater than 50% than the other 3 groups while compared to the low- dose group as well as control group, the CTFC were greater in the medium dose group. Furthermore, the LVEF of the medium-dose group was much better than that of the low-dose group. Compared to other groups, the left ventricular end-diastolic and end-systolic dimensions of the high-dose group remained suggestively elevated.
No takes yet. Share an insight, caveat, or question.
Gandhi et al. (2023) conducted an RCT in acute ST-segment elevation myocardial infarction (STEMI) (n=272). Tirofiban vs. control was evaluated on clinical outcomes including corrected TIMI frame count, TIMI grade 3, and ST-segment resolution. High-dose tirofiban during primary PCI for STEMI resulted in higher rates of corrected TIMI frame count, TIMI grade 3 flow, and ST-segment resolution >50% compared to lower doses and control.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: