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

To investigate the benefits of intracoronary high-dose tirofiban during primary percutaneous coronary intervention (PCI) for patients with acute ST-segment elevation myocardial infarction (STEMI) .Methods Fifty-eight patients with STEMI presented within 12 h of symptoms were randomly allocated to study group (n = 28,intracor-onary high-dose tirofiban) and control group (n = 30,intravenous high-dose tirofiban) .The culprit vessels were targe-ted 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 revascu-larization) 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,respec-tively) .No significant difference in hemorrhagic complications in hospital between groups was noted (P = 0.61) .Conclusions The study indicates that intracoronary high-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.