Key result
Early administration of tirofiban before reperfusion therapy significantly improved functional heart parameters and reduced inflammatory factors compared to intraoperative administration.
Why the study?
The study evaluated the efficacy and safety of early versus late tirofiban administration in patients with acute STEMI and diabetes mellitus undergoing pPCI.
Does preoperative administration of tirofiban improve myocardial perfusion and heart function compared to intraoperative administration in patients with STEMI and diabetes mellitus undergoing pPCI?
RCT (n=120)
Randomized
Does preoperative administration of tirofiban improve myocardial perfusion and heart function compared to intraoperative administration in patients with STEMI and diabetes mellitus undergoing pPCI?
Early preoperative administration of tirofiban in STEMI patients with diabetes undergoing pPCI improves myocardial perfusion and cardiac function without increasing bleeding risk compared to intraoperative administration.
Early tirofiban may improve reperfusion markers in diabetic STEMI; leaves open optimal timing pending larger trials.
OBJECTIVE: This study evaluated the efficacy and safety of early vs. late tirofiban administration in the treatment of patients with acute ST-elevation myocardial infarction (STEMI) and diabetes mellitus (DM) undergoing primary percutaneous coronary intervention (pPCI). METHODS: 120 patients with STEMI and DM treated with pPCI were randomly divided into an observation group (n=60) and a control group (n=60). The observation group and the control group were intravenously injected with a bolus of tirofiban preoperatively or intraoperatively, respectively; both groups were then given an intravenous infusion over 24 h at 0.15 μg/kg/min. Thrombolysis in myocardial infarction (TIMI) grade flow, myocardial perfusion index, and functional heart parameters, as well as major adverse cardiovascular events and bleeding, were compared between the two groups. RESULTS: Functional heart parameters, including left ventricular ejection fraction and cardiac output, were significantly improved in the observation group 6 months after discharge. Thrombus aspiration, inflammatory factors, and cardiac troponin I (cTNI) were more significantly decreased in the observation group than in the control group. The sum-ST-segment elevation at 2 h after pPCI treatment in the observation group was better than that in the control group. There was no significant difference in the incidence of adverse reactions and bleeding between the two groups. CONCLUSION: The administration of tirofiban before reperfusion therapy compared with after reperfusion therapy is more effective in reducing the hyperthrombotic load, thrombus aspiration, inflammatory factors, and cTNI and can effectively improve myocardial perfusion and heart function.
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Tang et al. (2023) conducted an RCT in Acute ST-elevation myocardial infarction (STEMI) and diabetes mellitus (DM) (n=120). Early tirofiban administration (preoperatively) vs. Late tirofiban administration (intraoperatively) was evaluated on Functional heart parameters, thrombus aspiration, inflammatory factors, and cardiac troponin I. Early administration of tirofiban before reperfusion therapy significantly improved functional heart parameters and reduced inflammatory factors compared to intraoperative administration.
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