Key result
Combined administration of tirofiban with low-dose alteplase prior to primary PCI significantly improved pre-interventional TIMI flow ≥2 (90.9% vs 34.8%) and ST elevation resolution compared to tirofiban alone in STEMI patients.
Why the study?
Does tirofiban combined with low dose alteplase improve TIMI flow and ST elevation resolution in patients with STEMI undergoing primary PCI?
RCT (n=45)
Randomized
No
Does tirofiban combined with low dose alteplase improve TIMI flow and ST elevation resolution in patients with STEMI undergoing primary PCI?
The addition of low-dose alteplase to tirofiban prior to primary PCI in STEMI improves pre-interventional TIMI flow and ST-segment resolution without significantly increasing bleeding risk.
Supports adjunctive low-dose alteplase with tirofiban pre-PCI in STEMI; extends RCT evidence on facilitated reperfusion strategies.
Background and Objectives：The combination of platelet glycoprotein IIb/IIIa inhibitors and a low dose thrombolytic agent may produce early Thrombolysis In Myocardial Infarction (TIMI) 3 flow and a high rate of ST elevation resolution in an ST elevation acute myocardial infarction (STEMI). The clinical effect of tirofiban combined with low dose alteplase, prior to primary percutaneous coronary intervention (PCI) in STEMI, were evaluated on the ST elevation resolution, TIMI flow and 30-day clinical outcomes. Subjects and Methods：Following aspirin, clopidogrel and standard heparin, 45 patients with STEMI were randomized into 2 groups; tirofiban administration (Group I; n=23, 64±10 years; 15 male) or combined administration of tirofiban with 40 mg alteplase prior to primary PCI (Group II; n=22, 59±11 years; 19 male). The pre- and post-interventional TIMI flow grades, ST elevation resolution and bleeding complications were compared between the two groups. The major adverse cardiac events (MACE) were compared between the two groups during 30-days of clinical follow-up. Results： Group II had a higher pre-interventional TIMI flow (TIMI flow≥2: 34.8% vs. 90.9%, p<0.0001) and rate of ST elevation resolution (49.0±27.8% vs. 66.6±27.2%, p=0.045) than Group I. A major bleeding complication developed in 1 (5.0%) Group II patient, and minor bleeding complications developed 1 patient from each group (Group I; 9.5% vs. Group II; 10%, p=0.959). Conclusion：Combined administration of tirofiban with alteplase prior to primary PCI leads to a higher TIMI flow and more frequent ST elevation resolution, without bleeding complications, compared to a single administration of tirofiban. (Korean Circulation J 2005;35:362-368)
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Kim et al. (2005) conducted an RCT in ST elevation acute myocardial infarction (STEMI) (n=45). Tirofiban combined with low dose alteplase vs. Tirofiban alone was evaluated on Pre-interventional TIMI flow ≥2 (p=<0.0001). Combined administration of tirofiban with low-dose alteplase prior to primary PCI significantly improved pre-interventional TIMI flow ≥2 (90.9% vs 34.8%) and ST elevation resolution compared to tirofiban alone in STEMI patients.
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