[Short- or long-outcome of early tirofiban in ST-segment elevated acute myocardial infarction undergoing elective percutaneous coronary intervention]
Related Experiment Video
Updated: Apr 29, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
You Zhang, Chuanyu Gao1, Muwei Li
1Department of Cardiology, Zhengzhou University People's Hospital, Henan Institute of Cardiovascular Epidemiology, Zhengzhou 450003, China.
Insights
Early tirofiban treatment before percutaneous coronary intervention (PCI) offers no significant advantage over provisional administration in ST-segment elevated acute myocardial infarction (STEMI) patients. Both strategies demonstrated similar efficacy and safety outcomes, including reduced thrombus events and bleeding complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- ST-segment elevated acute myocardial infarction (STEMI) is a critical condition requiring timely reperfusion therapy.
- Percutaneous coronary intervention (PCI) is a primary treatment for STEMI, often accompanied by antiplatelet therapy.
- The optimal timing for administering tirofiban, a glycoprotein IIb/IIIa inhibitor, in STEMI patients undergoing elective PCI remains under investigation.
Purpose of the Study:
- To investigate the optimal timing for early tirofiban administration in STEMI patients undergoing elective PCI.
- To compare the efficacy and safety of routine early tirofiban treatment versus provisional administration during or after PCI.
Main Methods:
- A randomized study involving 104 STEMI patients undergoing elective PCI.
- Patients were assigned to either an early tirofiban treatment group (administered ≥ 4 hours before angiography) or a control group (provisional administration).
- Outcomes assessed included Thrombolysis in Myocardial Infarction (TIMI) flow, creatine kinase MB isoenzyme (CK-MB) levels, acute thrombus events, and clinical endpoints (death, myocardial infarction, revascularization, stroke, bleeding, thrombocytopenia) up to 1 year.
Main Results:
- No significant differences were observed in TIMI flow, CK-MB levels, or acute thrombus events between the early and provisional tirofiban groups.
- Efficacy endpoints (death, myocardial infarction, target vessel revascularization, ischemic stroke) showed no statistical difference at various follow-up points (Day 7, Day 30, 6 months, 1 year).
- Both groups exhibited similar rates of slight bleeding and thrombocytopenia, with no severe complications reported in either arm.
Conclusions:
- Early administration of tirofiban is not superior to provisional treatment during or after PCI in STEMI patients undergoing elective procedures.
- The findings suggest that provisional tirofiban administration is a viable and equally effective strategy in this patient population.
- Trail registration: ChiCTR-TRC-10000809.
Objective:
To explore the optimal timing of tirofiban early treatment in ST-segment elevated acute myocardial infarction (STEMI) undergoing elective percutaneous coronary intervention (PCI).
Methods:
A total of 118 consecutive STEMI patients were enrolled in the study. They were randomly assigned to the tirofiban early treatment group with tirofiban administrated routinely at ≥ 4 hours prior to angiography or the control group with tirofiban provisional administrated during or after angiography. Thrombolysis in myocardial infarction (TIMI) flow, creatine kinase MB isoenzyme (CK-MB) levels, acute thrombus events, efficacy and safety endpoints at Day 7, Day 30, 6 months and 1 year (efficacy endpoints: death, myocardial infarction, target vessel revascularization and ischemic stroke; safety endpoints: bleeding and thrombocytopenia) were observed and compared between the two groups.
Results:
A total of 104 STEMI patients underwent elective PCI with 52 patients in each group and the baseline characteristics were balanced between the two groups. Tirofiban was administered (5.9 ± 2.9) hours earlier in the tirofiban early treatment group than the control group. No statistical difference was observed between the two groups in TIMI flow before[grade 0: 18 (34.6%) vs 19 (36.5%) , grade 3: 28 (53.8%) vs 27 (51.9%)] and after PCI[grade 3: 52 (100.0%) vs 51 (98.1%)]. No difference was shown between the two groups in CK-MB levels before PCI [(12.9 ± 5.1) U/L vs (12.0 ± 5.2) U/L, P > 0.05]; and the increase of CK-MB 12-24 hours after PCI [(1.0 ± 6.2) U/L vs (2.3 ± 8.3) U/L, P > 0.05]. The incidence of acute thrombus events was similar (7.7% vs 15.4%, P > 0.05). No statistical difference was observed between the two groups in the efficacy endpoints at Day 7 (0.0% vs 7.7%, P > 0.05), Day 30 (0.0% vs 7.8%, P > 0.05), 6 months (2.0% vs 9.8%, P > 0.05) and 1 year (2.2% vs 9.8%, P > 0.05). Similar incidence was shown in the slight bleeding (15.4% vs 5.8%, P > 0.05) and the slight thrombocytopenia (0.0% vs 1.9%, P > 0.05), while no severe to moderate bleeding or severe thrombocytopenia happened in both groups.
Conclusion:
Tirofiban early treatment is not better than the tirofiban bailout treatment during or after PCI in STEMI patients undergoing elective PCI. Trail registration ChiCTR-TRC-10000809.
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