Short-term effects of upstream high bolus dose of tirofiban in patients with ST segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

BACKGROUND: No-reflow following primary percutaneous coronary intervention (PPCI) is challenging to treat. OBJECTIVES: The objective of this study is to evaluate the efficacy and safety of upstream high-bolus-dose tirofiban administration in ST-segment elevation myocardial infarction (STEMI) cases undergoing PPCI on top of dual antiplatelet therapy, including ticagrelor, in comparison to selective bailout administration. METHODS: This hospital-based, randomized, single-blinded prospective interventional study was conducted on 150 patients at Assiut University Heart Hospital. Patients with STEMI within 12 h after symptom onset who underwent PPCI were randomized to an upstream group ( n = 75) and a selective bailout group ( n = 75) based on the timing of the tirofiban bolus administration (25 µg/kg intravenously over 5 min). RESULTS: The bailout group's thrombolysis in myocardial infarction (TIMI) frame count was higher than the upstream group's, despite comparable TIMI flow and myocardial blush grade between the two groups, but only approached statistical significance [14.4 (4-36) vs 12.2 (5-55), P = 0.08]. The enzymatic infarct size tended to be lower in the upstream group. All echocardiographic findings were comparable between the two studied groups, with no significant difference ( P > 0.05). There was no significant difference between the two groups regarding clinical outcomes. CONCLUSION: Compared to selective bailout administration, upstream high bolus dose of tirofiban in STEMI patients undergoing primary coronary intervention did not significantly affect angiographic outcomes, left ventricular remodeling, or function, despite smaller infarction size.