Evaluation on the Safety and Efficacy of Tirofiban in the Treatment of Acute Coronary Syndrome

To evaluate the safety and efficacy of tirofiban, a specific inhibitor of the platelet glycoprotein Ⅱb/Ⅲa receptor, in the treatment of unstable angina and myocardial infarction without persistent ST elevation （acute coronary syndrome, ACS）, a total of 200 patients were randomly assigned to a heparin group and a tirofiban＋heparin group on double-blind basis and the treatment effects of the two protocols on ACS were compared when the patients of both groups were taking aspirin at the same time. The composite primary end-point events consisted of death, myocardial infarction, or refractory ischemia. Our results showed that the frequency of the composite primary end point events in 30 days was lower in tirofiban＋heparin group as compared with that of heparin group （13.9% vs 29.3 %, P=0.010）. The rates of the other composite end point events in the tirofiban＋heparin group were also lower than those in the heparin group in 4.5 days and in 30 days. Bleeding complication occurred in 7.0% of the patients receiving heparin alone and in 12.7% of the patients receiving tirofiban and heparin in combination （P=0.1717）. The study showed that the incidence of ischemic events in patients with ACS receiving tirofiban＋heparin was lower when compared with that of patients who received only heparin and aspirin, suggesting that tirofiban might be of special value in the treatment of ACS.

Effects of intracoronary injection of nicorandil and tirofiban on myocardial perfusion and short-term prognosis in elderly patients with acute ST-segment elevation myocardial infarction after emergency PCI

BACKGROUND:This study investigated the effects of the intracoronary injection of nicorandil and tirofiban on myocardial perfusion and short-term prognosis in elderly patients with acute ST-segment elevation myocardial infarction(STEMI)after emergency percutaneous coronary intervention(PCI).METHODS:Seventy-eight STEMI patients with age>65 years who underwent emergency PCI were consecutively enrolled.These patients received conventional PCI and were randomly divided into a control group and a treatment group(n=39 per group).The control group received an intracoronary injection of tirofiban followed by a maintenance infusion for 36 hours after surgery.The treatment group received intracoronary injection of tirofiban and nicorandil,and then intravenous infusion of tirofiban and nicorandil 36 hours after surgery.The following parameters were measured:TIMI grade,corrected TIMI frame count(c TFC),TIMI myocardial perfusion grade(TMPG),STsegment resolution(STR)rate 2 hours post-operatively,resolution of ST-segment elevation(STR)at 2 hours postoperatively,peak level of serum CK-MB,left ventricular end diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF)at 7–10 days postoperatively,and major adverse cardiac events(MACEs)in-hospital and within 30 days post-operatively.RESULTS:Compared with the control group,more patients in the treatment group had TIMI 3 and TMPG 3,and STR after PCI was significantly higher.The treatment group also had significantly lower c TFC,lower infarction relative artery(IRA),lower peak CK-MB,and no reflow ratio after PCI.The treatment group had significantly higher LVEDD and LVEF but lower incidence of MACEs than the control group.CONCLUSION:The intracoronary injection of nicorandil combined with tirofiban can effectively improve myocardial reperfusion in elderly STEMI patients after emergency PCI and improve shortterm prognoses.

Efficacy and safety of fondaparinux versus enoxaparin in patients undergoing percutaneous coronary intervention treated with the glycoprotein IIb/IIIa inhibitor tirofiban

Background: In worldwide, the mortality rate of acute myocardial infarction(AMI) raises year by year. Although the applications of percutaneous coronary intervention(PCI) and anticoagulants effectively reduce the mortality of patients with acute coronary syndrome(ACS), but also increase the incidence of bleeding. Therefore, drugs with stable anticoagulant effects are urgently required.Methods: We enrolled 894 patients with acute coronary syndrome who underwent percutaneous coronary intervention in Shenyang Northern Hospital from February 2010 to May 2012; 430 patients were included in the fondaparinux group(2.5mg/d), and 464 were included in the enoxaparin group(1mg/kg twice daily). Fondaparinux and enoxaparin were applied for 3–7 days. All patients were treated with tirofiban [10μg/kg for 3min initially and 0.15μg/(kg·min) for 1 to 3 days thereafter]. The primary efficacy endpoint was the incidence of a major adverse cerebrovascular or cardiovascular event. The primary safety endpoint was bleeding within 30 days and 1 year after percutaneous coronary intervention.Results: One-year data were available for 422 patients in the fondaparinux group and for 453 in the enoxaparin group. The incidence of a major adverse cerebrovascular or cardiovascular event(10.9% vs 12.6%, P=0.433) and cardiac mortality(0.5% vs 1.5%, P=0.116) were generally lower in the fondaparinux group than in the enoxaparin group, although the differences were not significant. Compared with the enoxaparin group, the fondaparinux group had a significantly decreased rate of bleeding at 30 days(0.9% vs 2.9%, P=0.040) and 1 year(2.4% vs 5.5%, P=0.018). In addition, the rate of major bleeding events was lower in the fondaparinux group, but this difference was not significant(0.2% vs 0.9%, 0.2% vs 1.1%).Conclusion: In tirofiban-treated patients with acute coronary syndrome undergoing percutaneous coronary intervention, fondaparinux presented similar efficacy for ischemia events as enoxaparin. However, fondaparinux significantly decreased the incidence of bleeding, thus providing safer anticoagulation therapy.

Comparison of efficacy and safety of native eptifibatide vs. tirofiban in patients with acute coronary syndrome undergoing percutaneous coronary intervention

To compare clinical outcomes and safety of eptifibatide or tirofiban in patients with acute coronary syndrome（ACS） undergoing percutaneous coronary intervention（PCI）. Methods：Thirty-six patients with ACS（unstable angina/non-ST-segment elevation myocardial infarction, UA/NSTEMI） who underwent PCI were randomly divided into two groups to receive eptifibatide or tirofiban treatment. Eptifibatide or tirofiban was predominantly initiated in the catheter laboratory before the intervention. In-hospital and 30-day MACE outcomes; bleeding as well as platelet counting were investigated in those two groups. Results：No in-hospital and 30-day MACE event occurred in the two groups. The number of ischemia leads after treatment reduced compared to that before PCI in the two groups. There was improvement in the number of ischemia leads for 24 h after administration in the tirofiban group than those in eptifibatide group（4.21 ± 2.46 vs. 3.89 ± 3.31, P =0.03）. The two groups showed no incidence of massive bleeding. Minor bleeding rates were 16.7% and 22.2% in the two groups respectively. Conclusion：Eptifibatide as an adjunct to PCI may further decrease the incidence of ischemia event in patients with ACS and improve the safety, but its long-term efficacy and side effects need further observation.

Effects of Tirofiban and Nicorandil on Effective Reperfusion and the Levels of IL-4 and sICAM-1 After PCI for Chronic Coronary Total Occlusion

Aim:The effects of tirofiban combined with nicorandil on effective reperfusion,and the levels of interleukin-4(IL-4)and soluble intercellular adhesion molecule-1(sICAM-1)after percutaneous coronary intervention(PCI)for chronic coronary total occlusion(CTO)were investigated.Method:From January 1,2017,to June 31,2019,a total of 40 patients with CTO receiving PCI in Shandong Qian-foshan Hospital were randomly divided into a control group(treated with single tirofiban)and a cocktail group(treated with nicorandil combined with tirofiban).Effective reperfusion was compared between groups.In addition,differences in coronary serum IL-4 and sICAM-1 levels before and 10 min after the operation were compared between groups,and the incidence rates of adverse reactions were observed.Finally,patient follow-up occurred at 1 month and 6 months,and the total incidence rates of adverse cardiac events in both groups were assessed.Results:The levels of IL-4 and sICAM-1 in the cocktail group significantly decreased after the operation(P<0.05).In addition,after the operation,significantly greater decreases in the IL-4 and sICAM-1 levels were observed in the cocktail group than the control group(P<0.05).The Seattle Angina Scale(SAQ)score of the cocktail group,compared with the control group,showed a significant improvement after vessel opening in the patients with CTO.At the 1-month follow-up,the SAQ score of the cocktail group,compared with the control group,indicated further improvements in terms of angina attack frequency.No significant differences were observed in the incidence rates of adverse reactions between groups(P>0.05).Conclusion:The treatment of patients with CTO undergoing PCI with nicorandil and tirofiban alleviated the inflam-matory response,improved the SAQ scores,and decreased the occurrence of angina pectoris in patients.Moreover,this treatment is safe and reliable,and has important clinical significance.

Effect of intracoronary sodium nitroprusside and tirofiban injection on myocardial injury in patients with no reflow in PCI

Objective: To study the effect of intracoronary sodium nitroprusside and tirofiban injection on myocardial injury in patients with no reflow in PCI. Methods: Patients with acute coronary syndrome who underwent PCI and had no reflow in Gong'an County People's Hospital in Hubei Province between August 2014 and July 2017 were selected as the research subjects and randomly divided into two groups, combined group accepted intracoronary sodium nitroprusside and tirofiban injection during PCI, and control group accepted intracoronary tirofiban injection during PCI. The serum levels of myocardial injury indexes, oxidative stress indexes and inflammatory mediators of the two groups were measured before treatment and 1 d after treatment. Results: 1 d after treatment, serum CK-MB, H-FABP, sFas, cMyBP-C, MPO, MDA, Caspase-3, MCP-1, IL-1β, IL-18, MMP2 and MMP9 levels of both groups were significantly lower than those before treatment whereas SOD and NQO-1 levels were higher than those before treatment, and serum CK-MB, H-FABP, sFas, cMyBP-C, MPO, MDA, Caspase-3, MCP-1, IL-1β, IL-18, MMP2 and MMP9 levels of combined group were significantly lower than those of control group whereas SOD and NQO-1 levels were higher than those control group. Conclusion: Intracoronary sodium nitroprusside and tirofiban injection can reduce the myocardial injury in patients with no reflow in PCI.

Effect of papaverine combined with tirofiban intracoronary injection on the degree of myocardial injury in patients with no reflow during PCI

Objective:To study the effect of papaverine combined with tirofiban intracoronary injection on the degree of myocardial injury in patients with no reflow during percutaneous coronary intervention (PCI).Methods: Patients who underwent PCI in Ankang Central Hospital between March 2014 and May 2017 were retrospectively studied and divided into two groups according to the intravascular drugs they received during PCI, combined group received papaverine combined with tirofiban intracoronary injection and control group received tirofiban intracoronary injection. The changes in myocardial injury indexes, platelet activation indexes and inflammatory molecules were measured before PCI as well as 24 h and 48 h after PCI.Results:Serum CK-MB, cTnI, MYO, IMA, CD62p, GPIIb/IIIa, MIP-1α, sICAM-1 and HMGB-1 levels as well as peripheral blood Lp-PLA2, PAF, P-selectin, ERK and NF-κB fluorescence intensity of both groups 24 h and 48 h after PCI were significantly lower than those before PCI, and serum CK-MB, cTnI, MYO, IMA, CD62p, GPIIb/IIIa, MIP-1α, sICAM-1 and HMGB-1 levels as well as peripheral blood Lp-PLA2, PAF, P-selectin, ERK and NF-κB fluorescence intensity of combined group 24 h and 48 h after PCI were significantly lower than those of control group.Conclusion: papaverine combined with tirofiban intracoronary injection for PCI can reduce the degree of myocardial injury.

Effect of tirofiban combined with PCI on myocardial damage and platelet activation in patients with STEMI

Objective: To study the effect of tirofiban combined with PCI on myocardial damage and platelet activation in patients with STEMI. Methods: Patients with STEMI who were treated and underwent PCI in Wujiang First People's Hospital in Suzhou between March 2015 and February 2017 were selected as the research subjects and randomly divided into two groups, intervention group received tirofiban combined with PCI therapy, control group received routine PCI therapy, and the myocardial damage indexes and platelet activation indexes of two groups of patients were detected. Results: 24 h after PCI treatment, serum S100A/B, H-FABP, GDF-15, cTnT, FKN, MDA, sFas, sTWEAK and 8-OHdG levels of intervention group were obviously lower than those of control group;before PCI treatment and 24 h after PCI treatment, peripheral blood CD62p and PAC-1 expression intensity as well as serum P-selectin, thrombospondin and CD40 ligand levels of intervention group were obviously lower than those of control group. Conclusion: Tirofiban therapy before PCI can help alleviate myocardial damage and inhibit platelet activation.

Effect of shexiangbaoxin pill combined with tirofiban hydrochloride on related factors in elderly patients with acute coronary symdrome

Objective:To study the effect of shexiangbaoxin pill combined with tirofiban hydrochloride on related factors in elderly patients with acute coronary symdrome.Methods:A total of 96 elderly patients with acute coronary symdrome in our hospital from January 2015 to May 2018 were enrolled in this study. The subjects were divided into the control group (n=48) and the treatment group (n=48) randomly. The control group were treated with tirofiban hydrochloride, the treatment group were treated with shexiangbaoxin pill combined with tirofiban hydrochloride, and both the two groups were treated for 2 weeks. The PT, TT, APTT and serum FIB, CK-MB, cTnT, vWF, ET-1, NO, sICAM-1, MMP-9, hs-CRP of the two groups before and after treatment were compared. Results: There were no significantly differences of the PT, TT, APTT and serum FIB, CK-MB, cTnT, vWF, ET-1, NO, sICAM-1, MMP-9, hs-CRP of the two groups before treatment. The PT, TT, APTT and serum NO of the two groups after treatment were significantly higher than before treatment, the serum FIB, vWF, ET, sICAM-1, MMP-9, hs-CRP of the two groups after treatment were significantly lower than before treatment, and that of the treatment group after treatment were significantly better than the control group. The serum CK-MB, cTnT of the two groups after treatment were significantly higher than before treatment, but that of the treatment group after treatment were significantly lower than the control group.Conclusion:Shexiangbaoxin pill combined with tirofiban hydrochloride can significantly improve the blood coagulation function and reduce the Myocardial injury, vascular endothelial damage, inflammation of the elderly patients with acute coronary symdrome, and it was worthy clinical application.

Effect of tirofiban on inflammatory factors, endothelial function and cardiac function after interventional therapy in AMI patients

Objective:To investigate the effect of tironon on inflammatory factors, endothelial function and cardiac function after interventional therapy in AMI patients.Methods:A total of 120 patients with acute myocardial infarction in our hospital were selected as the research objects, all of them were in line with the indications of PCI operation. They were randomly divided into the observation group (60 cases) and the control group (60 cases). The control group was treated with aspirin and clopidogrel before and after PCI, and the observation group was treated with based on the use of tirofiban. Inflammatory factors, endothelial function and cardiac function index were detected and compared between the two groups.Results: Before treatment, there was no significant difference in hs-CRP, sCD40L and TNF-alpha levels in the two groups. After treatment, the hs-CRP of the two groups were (5.01±1.95) mg/L, (9.41±2.48) mg/L, sCD40L were (1.88±0.25) ng/mL, (2.77±0.27) ng/mL, TNF-α were (8.86±2.18) ng/L, (15.52±2.78) ng/L, respectively. The levels of hs-CRP, sCD40L and TNF-α in the two groups were all decreased, and the level of each index in the observation group was lower than that of the control group. There was no significant difference in NO, ET-1 and vWF levels between the two groups before treatment. After treatment, the NO of the two groups were (82.48±11.57) umol/L and (66.68±13.18) umol/L, respectively. The two groups of NO were all elevated, and the NO of the observation group was higher than that of the control group. After treatment, the ET-1 of the two groups were (55.03±6.58) ng/L, (66.17±5.42) ng/L, and vWF were (66.17±5.88)×10-2, (83.28±5.39)×10-2, respectively. The ET-1 and vWF of the two groups were all decreased, and the ET-1 and vWF of the observation group were lower than those of the control group. There was no significant difference in LVEF, LVESD and LVEDD between the two groups before treatment. After treatment, the LVEF, LVESD and LVEDD of the observation group were (63.87±6.43)%, (38.27±4.66) mm and (43.63±7.61) mm, respectively. The LVEF of the observation group was higher than that of the control group, and the LVESD and LVEDD were lower than that of the control group.Conclusion: Tirofiban can effectively improve the inflammatory factors, endothelial function and cardiac function of AMI patients after interventional therapy.

Efficacy and Safety of Tirofiban in Thrombolytic Therapyfor Ischemic Stroke

Objective:To evaluate the efficacy and safety of tirofiban hydrochloride in the treatment of ischemic stroke with thrombolytic therapy.Method:Two hundred patients with acute ischemic stroke thrombolysis were randomly divided into the experimental group and the control group.The experimental group was given tirofiban with the addition of rtpa in the control group and the therapeutic effects of the two groups were compared.Results:In comparison with the control group,the NIHSS improvement rate was 98%in the experimental group within 14 days.The platelet aggregation rate and efficacy in the experimental group were significantly reduced than the control group(P<0.01).The major adverse reaction in the two groups was hemorrhage with an incidence rate of 3%.Conclusion:Tirofiban hydrochloride is a highly effective and selective platelet glycoprotein Ⅱb/Ⅲa receptor inhibitor,which is safe and effective in combination with heparin and aspirin.

The influence of tirofiban on the troponin, brain natriuretic peptide, heart function in patients with Acute Myocardial Infarction after PCI

Objective:To observe the influence of tirofiban on the troponin, brain natriuretic peptide, heart function in patients with Acute Myocardial Infarction after PCI and provide scientific basis for treatment of acute myocardial infarction.Methods:A total of 100 cases of hypertensive cerebral hemorrhage patients in our hospital were selected and randomly divided into 2 groups: the control group (50 cases) and the observation group (50 cases). The conventional treatment of PCI was performed on both groups. Tirofiban injection was given to the observation group on the basis of conventional treatment. cTnI, BNP and echocardiography parameters (LVEF, LVEDD, LVESD) were detected before and after treatment.Results:The comparison of cTnI in the two groups before operation was not statistically significant. cTnI in the 2 groups increased 12 h and 24 h after operation. But the cTnI in observation group (0.10±0.23) ng/mL decreased more significantly than that in control group (0.24±0.31) ng/mL, the difference was considered to be statistically significant. The comparison of BNP in the two groups before operation was not statistically significant. BNP in the 2 groups decreased obviously 7 d and 30 d after operation. BNP in observation group decreased more significantly than that in control group and the difference was considered to be statistically significant LVEF in the observation group increased significantly compared with that in control group 7 d after operation. The comparison of LVEDD, LVESD were not considered to be statistically significant. LVEDD and LVESD in the observation group were lower than that in control group obviously 30 d after operation. While the LVEF in the observation group was still higher than that in the control group. The comparsion was considered to be statistically significant.Conclusion:Tirofiban can improve the troponin, brain natriuretic peptide, heart function in patients with Acute Myocardial Infarction after PCI. It can also decrease the heart injury as well as helping the recovery of heart function.

Effects of intracoronary arterial injection of tirofiban on no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction underwent primary percutaneous coronary intervention

Objective: To compare the effect of intracoronary arterial injection of tirofiban and sodium nitroprusside (SNP) on no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction (STEMI) underwent primary percutaneous coro-nary intervention (PCI). Methods: A total of 68 patients with acute STEMI who had no-reflow phenomenon during PCI were chosen and randomly divided into SNP group (n = 34) and tirofiban group (n = 34). Aiming at no-reflow phenomenon during PCI, with the use of microcatheters, intracoronary arterial injection of tirofiban was given in tirofiban group, while intracoronary bolus of SNP was given in SNP group. Coronary angiography was conducted to record TIMI flow grade of the infarct-related artery after 10 minutes. Plasma brain natriuretic peptide (BNP) was monitored before and after PCI (in 24 hours). With the help of ultrasound cardiogram, left ventricular ejection fraction (LVEF), left ventricular end-diastolic dimension (LVEDD) and left ventricular end-systolic dimension (LVESD) were recorded and compared in 30 days after PCI. Results: The ratio of TIMI grade 3 blood flow in tirofiban group was significantly higher than that in SNP group (76.5% (26/34) vs. 52.9% (18/34), p = .03)BNP levels in two groups had no statistical significance before PCI (p = .16), but in 24 h after PCI, BNP levels in tirofiban group were significantly lower than those in SNP group ((439.00 ± 4.90) μmol/L vs. (632.00 ± 3.63) μmol/L, p = .02)In 30 days after PCI, LVEF, LVEDD and LVESD in tirofiban group were all superior to those in SNP group (all p < .05). Conclusions: Intracoronary arterial injection of tirofiban was superior to SNP in improving no-reflow phenomenon in STEMI patients after PCI in the emergency treatment. Tirofiban therapy can increase coronary blood flow and myocardial perfusion after the occurrence of no-reflow phenomenon during PCI in STEMI patients, and improve long-term prognosis.

Early intravenous administration of tirofiban is recommended in patients with acute ischemic stroke treated with alteplase:a meta-analysis

Background:The occurrence of early neurological deterioration following intravenous thrombolysis(IVT)is considered a particularly ominous clinical event and is strongly correlated with poor outcomes.Initiating tirofiban within 24 h after IVT has been suggested as a better treatment option to achieve long-term functional outcomes.However,the rationality of this remedy is a controversial.The purpose of the study was to evaluate the safety and efficacy of early intravenous tirofiban administration after IVT in patients with acute ischemic stroke(AIS).Methods:Databases including PubMed,EMBASE,Cochrane Library,and Web of Science were searched for clinical trials on early tirofiban implementation after IVT in patients with AIS from inception to September 2022.Odds ratios(ORs)were generated for dichotomous variants via meta-analysis using STATA 17.0 MP.Results:Five clinical trials with 725 patients were eligible.The study outcomes demonstrated that early tirofiban administration after IVT was not associated with symptomatic intracranial hemorrhage(OR,0.78;95%confidence interval(CI),0.22–2.74;P=0.70),asymptomatic intracranial hemorrhage(OR,1.11;95%CI,0.52–2.37;P=0.80),systemic bleeding(OR,0.97;95%CI,0.42–2.23;P=0.94),and death(OR,1.05;95%CI,0.47–2.31;P=0.91),but may reduce the incidence of early neurological deterioration(OR,0.09;95%CI,0.02–0.50;P=0.01),and was significantly associated with 90-day excellent(modified Rankin scale score 0–1)(OR,2.01;95%CI,1.35–3.02;P=0.00)and favorable(modified Rankin scale score 0–2)(OR,2.30;95%CI,1.63–3.23;P=0.00)functional outcomes.Conclusion:The early intravenous administration of tirofiban after IVT in patients with AIS may be a safe and effective treatment strategy that improves long-term neurological functional outcomes without increasing the risk of adverse events.

Tirofiban有助于卒中患者溶解血块

来自于意大利佛罗伦萨Careggi医院的Martin oCellerin医师及其同事报道说，静脉注射血小板糖蛋白Ⅱb／Ⅲa拮抗剂tirofiban（TF，替罗非班）和机械溶栓似乎有望用于主要脑血管闭塞引起的严重卒中患者的治疗，糖蛋白抑制剂一直被用于急性缺血患者的治疗；该类制剂连同溶栓药物的使用可加速血块的溶解。

The Effect of the Early Application of Tirofiban on Acute Ischemic Stroke (AIS) after Intravenous Thrombolysis with Urokinase

Objective:Discussion and analysis of the effect of the early application of Tirofiban on acute ischemic stroke(AIS)after intravenous thrombolysis with urokinase.Method:The subjects of this study are 40 patients with AIS admitted at the Yibin Fourth People’s Hospital,of which were computer-randomized into a control group(20 cases,with regular urokinase intravenous thrombolysis therapy)and a research group(20 cases,combined with early Tirofiban treatment)from January 2018 to December 2022.The intervention outcomes between these two groups were compared and analyzed.Result:The blood platelet-related parameters before treatment had no statistical difference between the two groups(P>0.05),but the research group was higher than that of the control group after treatment(P<0.05).The Barthel index before treatment in both groups had no statistical difference(P>0.05),but the research group was higher than that of the control group after treatment(P<0.05).Conclusion:Early Tirofiban treatment for patients with AIS after intravenous thrombolysis with urokinase could effectively regulate the blood platelet-related parameters,hence improving treatment benefits and living capacity for patients,with definite clinical benefits.

Thrombus aspiration plus intra-infarct-related artery administration of tirofiban improves myocardial perfusion during primary angioplasty for acute myocardial infarction

Background We developed a new combined strategy of thrombus aspiration plus intra-infarct-related artery （IRA） bolus administration of tirofiban via the aspiration catheter in patients with ST-segment elevation myocardial infarction （STEMI）. This strategy can reduce the distal embolism and achieve highly localized concentrations of tirofiban, which can improve myocardial reperfusion without increasing the risk of bleeding. The aim of this study was to investigate whether this combined strategy is superior to thrombus aspiration alone in improving myocardial perfusion in patients with STEMI undergoing primary angioplasty.Results Baseline characteristics of the two groups were well-balanced. The TIMI 3 flow showed a better tendency in the intra-IRA group than in the aspiration alone group （97.22% vs. 87.04%, X2=7.863, P=0.049）. The peak of CK-MB （83.9 （68.9-310.5） U/L vs. 126.1 （74.7-356.7） U/L, P=0.034） and Tnl （42.7 （14.7-113.9） ng/ml vs. 72.5 （59.8-135.3） ng/ml, FMD.029） were lower in the intra-IRA group than in the aspiration alone group. LVEF in the hospital favored the intra-IRA group, （45.7±8.3）% to （42.9±12.1）%, t=1.98, P=0.049. There was a tendency towards a lower MACE at 9-month follow-up in the intra-IRA group although it did not reach statistical difference （Log-rank X2=2.865, P=0.09）. There was no statistical difference in any bleeding events between the two groups.Conclusions Thrombus aspiration plus intra-IRA bolus administration of tirofiban combined with angioplasty may be related with improved myocardium perfusion, saved more myocardium, and resulted in a better clinical prognosis.

Randomized comparison of intracoronary tirofiban versus urokinase as an adjunct to primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction： results of the ICTUS-AMI trial

Background No randomized trial has been performed to compare the efficacy of an intracoronary bolus of tirofiban versus urokinase during primary percutaneous coronary intervention （PCI）.We investigated whether the effects of adjunctive therapy with an intracoronary bolus of urokinase was noninferior to the effects of an intracoronary bolus of tirofiban in patients with ST-elevation myocardial infarction （STEMI） undergoing PCI.Methods A total of 490 patients with acute STEMI undergoing primary PCI were randomized to an intracoronary bolus of tirofiban （10 μg/kg; n=247） or urokinase （250 kU/20 ml; n=243）.Serum levels of P-selectin,von Willebrand factor （vWF）,CD40 ligand （CD40L）,and serum amyloid A （SAA） in the coronary sinus were measured before and after intracoronary drug administration.The primary endpoint was the rate of complete （＞70％） ST-segment resolution （STR） at 90 minutes after intervention,and the noninferiority margin was set to 15％.Results In the intention-to-treat analysis,complete STR was achieved in 54.4％ of patients treated with an intracoronary bolus of urokinase and in 60.6％ of those treated with an intracoronary bolus of tirofiban （adjusted difference：-7.0％;95％ confidence interval：-15.7％ to 1.8％）.The corrected TIMI frame count of the infarct-related artery was lower,left ventricular ejection fraction was higher,and the 6-month major adverse cardiac event-free survival tended to be better in the intracoronary tirofiban group.An intracoronary bolus of tirofiban resulted in lower levels of P-selectin,vWF,CD40L,and SAA in the coronary sinus compared with an intracoronary bolus of urokinase after primary PCI （P＜0.05）.Conclusions An intracoronary bolus of urokinase as an adjunct to primary PCI for acute STEMI is not equally effective to an intracoronary bolus of tirofiban with respect to improvement in myocardial reperfusion assessed by STR.This may be caused by less reduction in coronary circulatory platelet activation and inflammation.

Effect of tirofiban plus clopidogrel and aspirin on primary percutaneous coronary intervention via transradial approach in patients with acute myocardial infarction

Background Aspirin and clopidogrel can improve myocardial reperfusion and alleviate myocardial injury during percutaneous coronary intervention （PCI）. Whether the addition of intravenous tirofiban during this procedure produces further benefit has not been clarified in ST segment elevation myocardial infarction （STEMI） patients. We evaluated this on STEMI patients who underwent primary PCI （p-PCI） via transradial artery approach. Methods Consecutive patients were randomized into tirofiban group （n=-72） or placebo group （n=-78）. Angiographic analysis included initial and final thrombolysis in myocardial infarction （TIMI） flow grade （TFG）, corrected TIMI frame count （CTFC） and TIMI myocardial perfusion grade （TMPG） of the thrombotic vessel. Platelet aggregation rate （PAR）, creatine phosphokinase （CPK）, CPK isoenzyme MB （CPK-MB） and troponin I levels were measured and TIMI definitions were used to assess bleeding complications. Left ventricular performance parameters were investigated with equilibrium radionuclide ventriculography. Major adverse cardiac events （MACE） were followed up for 6 months. Results The cases of TFG 0 and 1 before PCI, TFG 0 when first crossing of guide wire were less, and the cases of TFG 3 after PCI was more in tirofiban group than those in placebo group. The final CTFC was fewer and the incidence of no reflow phenomenon was lower, as well the percentage of final TFG 3 was higher in tirofiban group than those in placebo group （all P 〈0.05）. Mean peak CPK-MB was significantly lower, while the left ventricular performance parameters 1 week after PCI were much more improved in tirofiban group than those in the placebo group. PAR was significantly decreased shortly after tirofiban infusion. The incidence of 6-month MACE in tirofiban group was obviously lower than that in the placebo group. No statistical difference was noted between the two groups with regard to bleeding complications. Conclusions Intravenous tirofiban infusion, in addition to aspirin and clopidogrel in STEMI patients with p-PCI via transradial artery access, can quickly inhibit platelet aggregation, loosen occlusive thrombus, improve myocardial reperfusion and reduce incidence of MACE with few complications of vessel access and bleeding.