Key result
Intracoronary tirofiban cuts MACE ~58% vs intravenous bolus in diabetic STEMI patients undergoing PCI.
Why the study?
The application and comparative efficacy of intracoronary versus intravenous tirofiban bolus in STEMI patients with diabetes and high thrombus burden undergoing PCI was unclear.
Does intracoronary tirofiban bolus improve cardiac function, biomarkers, and clinical outcomes compared to intravenous tirofiban bolus in patients with STEMI and diabetes undergoing PCI with high thrombus burden?
RCT (n=200)
Randomization method
No
Does intracoronary tirofiban bolus improve cardiac function, biomarkers, and clinical outcomes compared to intravenous tirofiban bolus in patients with STEMI and diabetes undergoing PCI with high thrombus burden?
Absolute Event Rate: 10% vs 24%
p-value: p=0.008
Intracoronary administration of tirofiban may be more effective than intravenous administration in improving myocardial perfusion, cardiac function, and short-term clinical outcomes in diabetic patients with STEMI and high thrombus burden undergoing PCI.
Supports intracoronary tirofiban preference in diabetic STEMI PCI; extends route-specific evidence to this high-risk subgroup.
OBJECTIVES: To investigate the application of tirofiban in patients with acute myocardial infarction complicated with diabetes and undergoing emergency interventional therapy. METHODS: Two hundred patients with acute ST-segment elevation myocardial infarction (STEMI) complicated with diabetes who underwent percutaneous coronary intervention (PCI) and found to have high thrombus burden in coronary artery admitted to our hospital from September 2018 to September 2020 were selected as subjects, and were divided into two groups according to the randomization method: the intravenous tirofiban bolus group and the intracoronary tirofiban bolus group, with 100 cases in each group. The levels of LVEF, LVESD and LVEDD were detected immediately after admission and 15 days after therapy, and the enzyme-linked immunosorbent assay was utilized to detect the levels of CK-MB, MMP-9 and hs-CRP. Furthermore, the levels of BNP, TNI, CR and UREA of the patients were analyzed, and the levels of ESR and FIB were detected with an automatic blood rheology analyzer to analyze the TIMI classification and the incidence of MACE in the two groups. RESULTS: Significant differences were seen between the two groups in the levels of various indicators after therapy. Fifteen days after therapy, the levels of LVEF and LVEDD were higher and the level of LVESD was lower in the intracoronary tirofiban bolus group than in the intravenous tirofiban bolus group (p<0.05); 3d after therapy, the levels of CK-MB, MMP-9 and BNP in the intracoronary tirofiban bolus group were lower than those in the intravenous tirofiban bolus group (p<0.05); 3d after therapy, the levels of TNI (p<0.05), CR and UREA in the intracoronary tirofiban bolus group were lower than those in the intravenous tirofiban bolus group, with no statistical difference (p>0.05); Similarly, 3d after therapy, the levels of TNI, Cr and Urea, as well as ESR, FIB and hs-CRP were lower in the intracoronary tirofiban bolus group than in the intravenous tirofiban bolus group (p<0.05). Compared with the intravenous tirofiban bolus group, the intracoronary tirofiban bolus group had a lower number of patients with Grade-0 and Grade-1, but a higher number of patients with Grade-2 and Grade-3 (p<0.05); Moreover, the incidence of MACE in the intracoronary tirofiban bolus group was lower than that in the intravenous tirofiban bolus group (p<0.05). CONCLUSION: In patients with STEMI complicated with diabetes who underwent PCI and found to have high thrombus burden in coronary artery, intracoronary bolus of tirofiban boasts superior therapeutic efficacy over intravenous bolus of tirofiban in significantly improving cardiac function, reducing myocardial cell damage, and improving renal function and myocardial inflammation of patients.
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Tang et al. (2021) conducted an RCT in Acute ST-segment elevation myocardial infarction (STEMI) complicated with diabetes (n=200). Intracoronary tirofiban vs. Intravenous tirofiban (10 μg/kg IV bolus prior to PCI, followed by 0.15 μg/(kg.min) continuous IV infusion) was evaluated on Incidence of Major Adverse Cardiac Events (MACE) (p=0.008). Intracoronary bolus of tirofiban significantly reduced the incidence of major adverse cardiac events to 10.0% compared to 24.0% with intravenous bolus in patients with STEMI and diabetes undergoing PCI.
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