Dose-related outcome of intra-coronary tirofiban in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

ZHANG Huan-ji; WEI Wen-bin; ZHANG Xin-xia; YAN Wen; WU Jian-sheng; HU Xue-song

摘要：Background Increasing studies were designed to admiruster a low bolus of intracoronary tirofiban to achievebeneficial outcomes. However, the appropriate dose via coronary for patients undergoing percutaneous coronary intervention with acute ST-segment elevation myocardial infarction (STEMI) is needed to be investigated. Methods Eighty three patients with STEMI presented within 12 hrs of symptoms were randomly allocated to high-dose group (n = 28), low-dose group (n = 35) and control group (n = 30). The culprit vessels were targeted with primary PCI in all patients. Clinical characteristics, angiographic findings, brain natriuretic peptide (BNP) at 7-day and in-hospital outcomes were compared among groups, as well as left ventricular ejection fraction (LVEF) and major adverse cardiac events (MACE) at 30-day clinical follow-up. Results High-dose and low-dose groups showed better thrombolysis in myocardial infarction (TIMI) flow grades immediately after PCI (P = 0.02) and lower incidence of the 30-day composite major cardiac adverse events than the control group, but there was not significant difference between high-dose and low-dose group. The LVEF and BNP in the studied groups at 7 days were better than those in the control group (P = 0.04 and P = 0.04, respectively). No significant difference in hemorrhagic complications in hospital between groups were noted (P = 0.76).Conclusions Intracoronary bolus administration of tirofiban for patients with STEMI undergoing primary PCI can improve the reperfusion level in the infarcted area and clinical outcomes in 30-day follow-up. It is superior to intravenous bolus injection for improving coronary flow, LVEF and short-term clinical outcomes. However, increasing dose of intracoronary tirofiban doesn't show significant differences.