Related Experiment Video
Updated: Mar 14, 2026
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Assessment of No-Reflow in Patients With STEMI After Intracoronary Tirofiban After Opening of the Vessel
Mohammed Ali Mohammed Hammad1, Wael Anwar Elshahat Hassib1, Mohamed Kamal Ibrahim Salama1
1Cardiology Department, Faculty of Medicine, Kafr Elsheikh University, Kafr Elsheikh, Egypt.
Insights
Intracoronary tirofiban effectively reduces the no-reflow phenomenon (NRP) after primary percutaneous coronary intervention (PPCI) in ST-segment elevation myocardial infarction (STEMI) patients, improving coronary flow and reducing major adverse cardiac events (MACE).
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- No-reflow phenomenon (NRP) is a critical complication after primary percutaneous coronary intervention (PPCI) in ST-segment elevation myocardial infarction (STEMI).
- Successful epicardial recanalization does not always prevent NRP, leading to adverse outcomes.
- Identifying effective strategies to mitigate NRP is crucial for improving STEMI patient prognosis.
Purpose of the Study:
- To evaluate the efficacy of intracoronary (IC) tirofiban in preventing NRP following PPCI in STEMI patients.
- To assess the impact of IC tirofiban on coronary flow restoration and clinical outcomes.
- To determine the safety profile of IC tirofiban, including bleeding complications.
Main Methods:
- A randomized controlled double-blind study involving 60 STEMI patients undergoing successful PPCI.
- Patients with suboptimal coronary flow (TIMI grade < 3) received either IC tirofiban (25 ug/kg) or placebo (0.9% saline).
- Outcomes assessed included TIMI flow grade, NRP incidence, ST-T normalization, bleeding complications, and major adverse cardiac events (MACE) at 30 days.
Main Results:
- The tirofiban group showed significantly higher rates of TIMI 3 flow (80% vs. 46.67%) and lower NRP incidence (20% vs. 53.33%) compared to placebo (P = 0.007 for both).
- Minor bleeding complications were higher in the tirofiban group (26.67% vs. 3.33%, P = 0.026), with no significant difference in major bleeding.
- In-hospital MACE were substantially reduced in the tirofiban group (3.33% vs. 30%, P = 0.012).
Conclusions:
- Intracoronary tirofiban is effective in reducing NRP and improving coronary flow after PPCI in STEMI.
- IC tirofiban administration leads to a significant reduction in MACE.
- While associated with increased minor bleeding, IC tirofiban offers a favorable risk-benefit profile for managing NRP in STEMI.
Background:
No-reflow phenomenon (NRP) following primary percutaneous coronary intervention (PPCI) remains a critical determinant of adverse outcomes in ST-segment elevation myocardial infarction (STEMI) cases despite successful epicardial recanalization. The core purpose of this study was to establish the value of intracoronary (IC) tirofiban, delivered via the IC route, in mitigating the occurrence of NRP for STEMI cases subsequent to successful vessel reopening.
Methods:
This randomized controlled double-blind study enrolled 60 STEMI cases. Following successful PCI, cases with thrombolysis in myocardial infarction (TIMI) flow grade less than 3 were randomized to receive either IC tirofiban (25 ug/kg) or saline 0.9% as placebo, in addition to standard pre-procedural therapy with aspirin, heparin, and ticagrelor. TIMI flow grade and incidence of NRP were evaluated. Additionally, ST-T normalization in electrocardiogram (ECG) was assessed. Bleeding complications and major adverse cardiac events (MACEs) were recorded during hospitalization and at 30-day follow-up.
Results:
The tirofiban group demonstrated notably superior coronary flow restoration with 80% achieving TIMI 3 flow versus 46.67% in controls (P = 0.007). NRP occurred in 20% of tirofiban cases compared to 53.33% in controls (P = 0.007). Minor bleeding complications increased in the tirofiban group (26.67% versus 3.33%, P = 0.026), while major bleeding remained absent in both groups. Total in-hospital MACEs were notably reduced with tirofiban treatment compared to controls (3.33% versus 30%, P = 0.012).
Conclusions:
In STEMI cases following PPCI, IC tirofiban administration effectively reduces NRP, improves coronary flow restoration, and reduces MACE despite increased minor bleeding risk.
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Acute Coronary Syndrome I: Introduction
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations