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Primary Percutaneous Coronary Intervention with High-Bolus Dose Tirofiban: The FASTER (Favorite Approach to Safe and

Stefano Rigattieri1, Corrado Lettieri2, Gianluca Tiberti3

  • 1Interventional Cardiology, Sant'Andrea Hospital, Sapienza University, Rome, Italy.

Journal of Interventional Cardiology
|April 14, 2022
PubMed

Insights

Tirofiban use during primary percutaneous coronary intervention (pPCI) in STEMI patients showed a low rate of bleeding and major adverse coronary events (MACE). This study highlights tirofiban

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Pharmacology

Background:

  • Use of glycoprotein IIb/IIIa inhibitors (GPI) in primary percutaneous coronary interventions (pPCI) has decreased due to bleeding risks and newer oral antiplatelet drugs.
  • Concerns exist regarding suboptimal platelet inhibition with P2Y12-blockers like prasugrel and ticagrelor during pPCI.

Purpose of the Study:

  • To assess the safety and clinical efficacy of tirofiban in patients undergoing primary percutaneous coronary interventions (pPCI).
  • To evaluate bleeding events and major adverse coronary events (MACE) in patients receiving tirofiban during pPCI.

Main Methods:

  • A prospective multicenter registry (FASTER) enrolled 472 STEMI patients undergoing pPCI in high-volume Italian centers.
  • All patients received intraprocedural tirofiban, with safety assessed by Bleeding Academic Research Consortium (BARC) criteria.
  • Endpoints included in-hospital bleeding, MACE, final TIMI flow, myocardial blush grade, and ST-segment resolution.

Main Results:

  • The study enrolled 472 patients (mean age 61 years, 83% male) across 16 centers.
  • A low 30-day rate of BARC bleedings (2.1%) and MACE (0.8%) was observed.
  • Complete ST-segment resolution (>70%) was achieved in 67% of patients, with 88% undergoing transradial PCI.

Conclusions:

  • Intraprocedural tirofiban use during primary PCI in STEMI patients with high thrombus burden is associated with favorable outcomes.
  • The FASTER registry demonstrated low rates of in-hospital bleeding and MACE when tirofiban is used, particularly with the transradial approach.
  • Tirofiban administration in this context led to high rates of complete ST-segment resolution, suggesting effective myocardial reperfusion.
Abstract

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