Clinical benefits of intracoronary high-dose tirofiban therapy in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

ZHANG Huan-ji; ZHANG Xin-xia; WU Jian-sheng; HU Xue-song

摘要：Background To investigate the benefits of intracoronary nigh-dose tirofiban during primary percutaneous coronary intervention (PCI) for patients with acute ST-segment elevation myocardial infarction (STEMI).Methods Fiftyeight patients with STEMI presented within 12 h of symptoms were randomly allocated to study group (n = 28,intracoronary high-dose tirofiban) and control group (n = 30,intravenous high-dose tirofiban).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 between groups,as well as left ventricular ejection fraction (LVEF) and major adverse cardiac events (MACE,including death,reinfarction,worsening heart failure and target vessel revascularization) at 30-day clinical follow-up.Results Compared with the control group,the study group showed better thrombolysis in myocardial infarction (TIMI) flow grades immediately after PCI (96.4% vs 76.7 %,P = 0.02).The 30-day composite major adverse cardiac events rate was lower in the study group (3.6% vs 23.3%,P =0.02),and the LVEF and BNP in the study group at 7 days was better than that in the control group (P =0.01 and 0.02,respectively).No significant difference in hemorrhagic complications in hospital between groups was noted (P = 0.61).Conclusions The study indicates that intracoronary nigh-dose bolus administration of tirofiban for patients with STEMI who underwent primary PCI can significantly improve the reperfusion level in the infarct area and clinical outcomes at 30 days follow-up.It is better and safer to apply intravenous bolus injection for improving coronary flow,LVEF and short-term clinical outcomes.