Key result
Intracoronary tirofiban during STEMI PCI is associated with ~280% more patients achieving reduced infarct size vs IV.
Why the study?
To compare the efficacy of tirofiban bolus administration via PCI versus intravenous route for restoring myocardial perfusion in STEMI patients.
Does intracoronary administration of high dose bolus tirofiban improve myocardial perfusion compared to intravenous administration in STEMI patients undergoing primary PCI?
Cross-Sectional (n=168)
No
Does intracoronary administration of high dose bolus tirofiban improve myocardial perfusion compared to intravenous administration in STEMI patients undergoing primary PCI?
Absolute Event Rate: 22.61% vs 5.95%
p-value: p=0.0138
Intracoronary administration of bolus tirofiban during primary PCI for STEMI is associated with better ST-segment resolution and higher LVEF compared to intravenous administration, without increasing bleeding risk.
Intracoronary tirofiban was associated with better markers in STEMI PCI; hypothesis-generating and requires randomized confirmation before practice change.
Acute ST-elevation myocardial infarction (STEMI) is a condition in which transmural myocardial ischemia causes myocardial necrosis and is the leading cause of death. Objectives: To compare the efficacy of tirofiban bolus administration via percutaneous coronary intervention (PCI) and intravenous route (IV) in STEMI patients for restoration of myocardial perfusion. Methods: A retrospective cross-sectional study was conducted at Cardiology Department, Hayatabad Medical Complex, Peshawar, during 2021-22. The study comprised 168 STEMI patients divided into Group A and B (n=84), treated with tirofiban PCI and IV route, respectively. Results: Incidence of STEMI was three folds higher in males than females, and the mean age of the patients was 55 years. Smoking and obesity were the potential risk factors. Patients in Group A had a better clinical outcome and prognosis than Group B. In comparison to the IV treatment group (91.66%), the ST-segment resolution time was considerably lower (P<0.05) in the PCI group (48.80%). In both groups, the observational parameters for TIMI flow grade, TIMI major and minor bleeding, MBG, and MACE were not-significantly different (P≥0.05), comprising percentages 94, 3.57, 9.52, 71.42, 5.95%, and 84.52, 2.38, 13.09, 75, 15.47%, respectively. In comparison to IV therapy group, the LVEF percentage in PCI group was statistically significant (P<0.05) after 24 hours and 30 days (57, 63 and 52, 58%, respectively). Conclusions: It was concluded that STEMI patients treated with PCI tirofiban bolus had significantly greater (p<0.05) recovery rates, left ventricular ejection fractions and better clinical outcomes than IV-treated group
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Khan et al. (2022) conducted a cross-sectional in ST Elevation Myocardial Infarction (STEMI) (n=168). Intracoronary tirofiban bolus vs. Intravenous tirofiban bolus was evaluated on Reduced infarction size (p=0.0138). Intracoronary administration of tirofiban bolus during PCI significantly increased the proportion of patients with reduced infarction size (22.61% vs 5.95%) compared to intravenous administration in patients with STEMI.
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