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

Background Increasing studies were designed to administer a low bolus of intracoronary tirofiban to achieve beneficial 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.