Abstract
Objective: 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. Methods: 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. Results: 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. Conclusion: 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.
Original Article The effects of tirofiban infusion on clinical and angiographic outcomes of patients with STEMI undergoing primary PCI Cihangir Kaymaz 1, Nurşen Keleş 1, Nihal Özdemir 1, İbrahim Halil Tanboğa 1, Hacer C. Demircan 1, Mehmet M. Can 1, Fatih Koca 1, İbrahim Akın İzgi 1, Alper Özkan 1, Muhsin Türkmen 1, Cevat Kırma 1, Ali M. Esen 1 1 Department of Cardiology, Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital; İstanbul-Turkey Anatol J Cardiol 2015; 15: 899-906 DOI: 10.5152/akd.2014.5656 This article was viewed 61 times, downloaded 73 times Key Words: tirofiban, myocardial infarction, percutaneous coronary intervention, angiography, treatment outcome Full Text (PDF) Related Articles Send a comment Share Abstract Objective: 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. Methods: 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. Results: 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. Conclusion: 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. Turkish Başlık: Tirofiban infüzyonunun primer perkütan koroner girişim uygulanan ST-elevasyonlu miyokart enfarktüslü hastaların klinik ve anjiyografik sonuçları üzerine etkileri Anahtar Kelimeler: tirofiban, miyokart enfarktüsü, perkütan koroner girişim, anjiyografi, tedavi sonuçları Amaç: Bu çalışma Tirofiban (Tiro) ın perkütan koroner girişim (PKG) uygulanan ST elevasyonlu miyokart enfarktüslü (STEMİ) hastalarda anjiyografik ölçümler, ST segment rezolüsyonu ve klinik sonuçlar üzerine olan etkilerini araştırmayı amaçlamıştır. Yöntemler: Glikoprotein (GP) II b III a inhibtörlerinin primer PKG uygulanan STEMİ li hastalarda yararlı olduğu bilinmekle beraber Glikoprotein(GP) II b III a inhibtörlerinin bu hastalarda en etkili uygulama zamanı ile ilgili araştırmalar ve tartışmalar devam etmektedir. Primer PKG uygulanan 1242 [%83,0 erkek, ortalama (standart sapma; SS) yaş: 54,7(10,9) yıl] STEMİ'li hasta retrospektif randomize olmayan bu çalışmaya dahil edildi. Hastalar tirofiban uygulanması ve uygulama zamanına göre tirofiban almayan [Tiro (-); n=248],PKG öncesi tirofiban alan (pre-Tiro; n=720), PKG sırasında tirofiban alan (peri-Tiro; n=50) ve PKG sonrası tirofiban alan (post-Tiro; n=224) şeklinde dört alt gruba ayrıldı. Tüm tirofiban alan hastalar (10 µg/kg) bolus tirofiban dozu ardından ortalama 22,4±6,8 saat (0,15 μg/kg/min) dozunda Tiro infüzyonu aldılar. Bulgular: Pre-PKG Tiro alt grubu en yüksek TIMI 3 akım yüzdesine (%99,4; p<0,001),en düşük düzeltilmiş TIMI frame sayım değerine [21(18-23,4); p<0,001], en yüksek >%75 ST segment rezolüsyon yüzdesine (%78,1; p<0,001) ve en düşük hastane içi ani kardiyak ölüm ve tüm sebepli hastane içi ölüm oranlarına (%3,2, p<0,05, %3,3, p=0,01) sahip idi. Tirofiban alan hastaların 18 (%1,8) inde majör kanama kaydedildi. Sonuç: STEMI'li hastalarda primer PKG öncesinde aspirin, yüksek doz klopidogrel ve unfaksiyone heparine ek olarak standart doz bolus tirofiban kullanımı miyokard reperfüzyonunu, ST segment rezolüsyonunu, hastane içi mortaliteyi ve hastane içi ani kardiyak ölümü majör kanama riskini arttırmadan anlamlı olarak iyileştirmiştir.