Key result
Tirofiban plus heparin is linked to ~64% lower odds of no-reflow during emergency PCI.
Why the study?
The no-reflow phenomenon is an important complication of emergency PCI for ACS, motivating this evaluation of the association between adjunctive tirofiban and in-hospital angiographic and electrocardiographic reperfusion indicators.
Does adjunctive perioperative tirofiban combined with heparin reduce the incidence of the no-reflow phenomenon and improve myocardial perfusion compared with heparin alone in acute coronary syndrome patients undergoing emergency PCI?
Cohort (n=186)
No
Does adjunctive perioperative tirofiban combined with heparin reduce the incidence of the no-reflow phenomenon and improve myocardial perfusion compared with heparin alone in acute coronary syndrome patients undergoing emergency PCI?
In ACS patients undergoing emergency PCI, adjunctive tirofiban plus heparin was associated with a significantly lower incidence of intraoperative no-reflow and improved angiographic and electrocardiographic markers of myocardial reperfusion compared with heparin alone, though prospective confirmation is needed.
Answers are grounded in this paper and cite their sources.
Tirofiban was associated with lower no-reflow risk in emergency PCI; hypothesis-generating and should not yet change practice pending randomized trials.
The no-reflow phenomenon is an important complication of emergency percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). We examined the association between adjunctive tirofiban and in-hospital angiographic and electrocardiographic reperfusion indicators. This single-center retrospective observational study included 186 ACS patients who underwent emergency PCI between January 2021 and December 2024. According to perioperative antithrombotic treatment, patients were divided into a tirofiban plus heparin group (n = 92) and a heparin-alone group (n = 94). Because treatment assignment was nonrandom and determined by the treating interventional cardiologist, the analysis was designed to estimate associations rather than causal treatment effects. For the no-reflow outcome, a parsimonious multivariable logistic regression model adjusted for clinically relevant measured confounders, including diabetes mellitus, symptom-to-balloon time > 6 hours, high thrombus burden, and pre-PCI thrombolysis in myocardial infarction (grade/flow) (TIMI) 0–1 flow. No-reflow was recorded in 8/92 (8.7%) versus 20/94 (21.3%) patients ( P = .016). Final TIMI grade 3 flow occurred in 91.3% versus 79.8% ( P = .028); myocardial blush grade 2–3 in 84.8% versus 68.1% ( P = .008); TIMI myocardial perfusion grade 2–3 in 82.6% versus 66.0% ( P = .010); and ST-segment resolution > 70% in 65.2% versus 47.9% ( P = .017). The originally reported adjusted odds ratio for no-reflow associated with tirofiban was 0.36 (95% confidence interval 0.14–0.90; P = .029). Bleeding Academic Research Consortium major bleeding occurred in 3/92 (3.3%) versus 2/94 (2.1%; P = .679); Bleeding Academic Research Consortium minor bleeding in 6/92 (6.5%) versus 5/94 (5.3%; P = .733). These small event counts do not establish comparable safety. In ACS patients undergoing emergency PCI, tirofiban plus heparin was associated with a lower incidence of intraoperative no-reflow and with improved surrogate markers of epicardial and myocardial reperfusion compared with heparin alone. These findings are hypothesis-generating and require confirmation in prospective studies with standardized treatment protocols and longer-term clinical follow-up.
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Pan et al. (2026) conducted a cohort in Acute coronary syndrome undergoing emergency PCI (n=186). Tirofiban plus heparin vs. Heparin alone was evaluated on No-reflow phenomenon (OR 0.36, 95% CI 0.14-0.90, p=0.029). Tirofiban plus heparin was associated with lower no-reflow incidence than heparin alone in ACS emergency PCI.
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