The effects of tirofiban infusion on clinical and angiographic outcomes of patients with STEMI undergoing primary PCI

• Published in: Anatolian journal of cardiology Vol. 15; no. 11; pp. 899 - 906
• Main Authors: Kaymaz, Cihangir, Keleş, Nurşen, Özdemir, Nihal, Tanboğa, İbrahim Halil, Demircan, Hacer C, Can, Mehmet M, Koca, Fatih, İzgi, İbrahim Akın, Özkan, Alper, Türkmen, Muhsin, Kırma, Cevat, Esen, Ali M
• Format: Journal Article
• Language: English
• Published: Turkey Kare Publishing 01.11.2015
• Subjects: Aged; Coronary Angiography; Drug Administration Schedule; Female; Fibrinolytic Agents - administration & dosage; Fibrinolytic Agents - therapeutic use; Humans; Infusions, Intravenous; Male; Middle Aged; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - therapy; Original Investigation; Percutaneous Coronary Intervention; Retrospective Studies; Treatment Outcome; Tyrosine - administration & dosage; Tyrosine - analogs & derivatives; Tyrosine - therapeutic use
• ISSN: 2149-2263; 2149-2271
• DOI: 10.5152/akd.2014.5656

The present study was designed to determine the effects of tirofiban (Tiro) infusion on angiographic measures, ST-segment resolution, and clinical outcomes in patients with STEMI undergoing PCI. Glycoprotein (GP) IIb/IIIa inhibitors are beneficial in ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI), while the most effective timing of administration is still under investigation. A total of 1242 patients (83.0% males, mean (standard deviation; SD) age: 54.7 (10.9) years) with STEMI who underwent primary PCI were included in this retrospective non-randomized study in four groups, composed of no tirofiban infusion [Tiro (-); n=248], tirofiban infusion before PCI (pre-Tiro; n=720), tirofiban infusion during PCI (peri-Tiro; n=50), and tirofiban infusion after PCI (post-Tiro; n=224). In all Tiro (+) patients, bolus administration of Tiro (10 µg/kg) was followed by infusion (0.15 µg/kg/min) for a mean (SD) duration of 22.4±6.8 hours. The pre-PCI Tiro group was associated with the highest percentage of patients with TIMI 3 flow (99.4%; p<0.001), the lowest corrected TIMI frame count [21(18-23.4); p<0.001], the highest percentage of patients with >75% ST-segment resolution (78.1%; p<0.001), and the lowest rate of in-hospital sudden cardiac death and in-hospital all-cause mortality (3.2%, p<0.05, 3.3%, p=0.01). Major bleeding was reported in 18 (1.8%) patients who received tirofiban. Use of standard-dose bolus tirofiban in addition to aspirin, high-dose clopidogrel, and unfractionated heparin prior to primary PCI significantly improves myocardial reperfusion, ST-segment resolution, in-hospital mortality rate, and in-hospital sudden cardiac death in patients with STEMI with no increased risk of major bleeding.