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Intracoronary bolus‐only compared with intravenous bolus plus infusion of tirofiban application in patients with ST‐elevation myocardial infarction undergoing primary percutaneous coronary intervention
Author(s) -
Kırma Cevat,
Erkol Ayhan,
Pala Selçuk,
Oduncu Vecih,
Dündar Cihan,
İzgi Akın,
Tigen Kürşat,
Gibson C. Michael
Publication year - 2012
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.23109
Subject(s) - medicine , tirofiban , timi , bolus (digestion) , percutaneous coronary intervention , conventional pci , cardiology , myocardial infarction , perfusion , ejection fraction , anesthesia , heart failure
Objectives : The aim of this pilot study was to compare intracoronary bolus‐only with standard intravenous bolus plus maintenance infusion of tirofiban with respect to improvement in myocardial reperfusion after primary percutaneous coronary intervention (p‐PCI). Background : Changes in clinical practice may obviate the need for a maintenance infusion of small molecule glycoprotein IIb/IIIa inhibitors in current practice. Methods : Forty‐nine patients undergoing p‐PCI were randomized to either intracoronary bolus‐only ( n = 25) or intravenous bolus plus infusion ( n = 24) of tirofiban. The primary end point was coronary hemodynamic indices of microvascular perfusion measured 4–5 days after p‐PCI. The secondary end points were ST segment resolution at 90 min, the corrected TIMI frame count and myocardial blush grade. At 6 months, echocardiography and technetium‐99m single‐photon‐emission computed tomography were performed. Results : Microvascular perfusion did not differ significantly between the two treatment groups: index of microvascular resistance (27 ± 13 vs. 35 ± 15 U, P = 0.08) and coronary flow reserve (2.2 ± 0.7 vs. 1.9 ± 0.6, P = 0.25). The corrected TIMI frame counts assessed in the first ( P = 0.13) and the second ( P = 0.09) catheterization or the myocardial blush grades evaluated immediately ( P = 0.23) and 4–5 days after MI ( P = 1.00) were not significantly different between the two groups. At 6 months, there was no difference between the two groups in infarct size, left ventricular volumes, or ejection fraction. Conclusions : The standard intravenous bolus plus maintenance infusion of tirofiban in p‐PCI is not superior to intracoronary bolus‐only administration with respect to microvascular perfusion. Further, adequately powered randomized trials are warranted to evaluate the clinical outcomes associated with this strategy. © 2011 Wiley Periodicals, Inc.