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Randomized Controlled Trial
. 2019;30(5):285-289.
doi: 10.5830/CVJA-2019-027. Epub 2019 Jun 12.

Clinical outcome of intracoronary versus intravenous high-dose bolus administration of tirofiban in diabetic patients undergoing primary percutaneous coronary intervention

Ahmed A Ghonim  1 , Abdalla Mostafa  2 , Ahmed Emara  2 , Alaa S Algazzar  3 , Mohammed A Qutub  4
Affiliations
Randomized Controlled Trial

Clinical outcome of intracoronary versus intravenous high-dose bolus administration of tirofiban in diabetic patients undergoing primary percutaneous coronary intervention

Ahmed A Ghonim et al. Cardiovasc J Afr. 2019.

Abstract

Background: Previous trials remain inconsistent regarding the advantages and hazards related to intracoronary (IC) compared with intravenous (IV) administration of thrombolytics. We aimed to evaluate the safety and effectiveness of IC versus IV tirofiban administration in diabetic patients (DM) with acute ST-segment elevation myocardial infarction (STEMI) during primary percutaneous coronary intervention (PCI).

Methods: This trial included 95 patients who were randomised to high-dose bolus plus a maintenance dose of tirofiban administered either IV or IC. The groups were compared for the incidence of composite major adverse cardiac events (MACE) at 30 days. Levels of cardiac markers were recorded pre- and post-intervention for myocardial perfusion.

Results: The MACE were not different between the groups, but post-procedure myocardial blush grade (MBG) 3 and thrombolysis in myocardial infarction (TIMI) 3 flow were significant in the IC group (p = 0.45, 0.21, respectively), favouring the IC strategy. Peak values of both creatine kinase-muscle/brain (CK-MB) and high-sensitivity troponin T (hs-TnT) were significantly lower in the IC group (155.68 ± 121, 4291 ± 334 ng/dl) versus the IV group (192.4 ± 86, 5342 ± 286 ng/dl) (p = 0.021, p = 0.035, respectively). The peak value was significantly lower in the IC group than the IV group in terms of ST-segment resolution and 30-day left ventricular ejection fraction (LVEF) (p = 0.016 and 0.023, respectively).

Conclusion: Thirty days post PCI, IC tirofiban was more efficient in ameliorating blood flow in the coronary arteries and myocardial tissue perfusion in DM patients after STEMI despite bleeding events, and MACE rates showed no significant difference between the groups. The IC group showed better improvement in LVEF.

Keywords: STEMI; diabetes mellitus; intracoronary tirofiban; primary coronary intervention.

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Figures

Fig. 1
Fig. 1
Frequency of 50% ST-segment resolution in the groups.
Fig. 2
Fig. 2
Comparison of TIMI flow post intervention in the groups.
See this image and copyright information in PMC

References

    1. Farhan S, Hochtl T, Kautzky-Willer A, Wojta J, Huber K. Antithrombotic therapy in patients with coronary artery disease and with type 2 diabetes mellitus. Wien Med Chenschr. 2010;160:30–38. - PubMed
    1. Ergelen M, Uyarel H, Cicek G, Isik T, Osmonov D, Gunaydin ZY. et al. Which is worst in patients undergoing primary angioplasty for acute myocardial infarction? Hyperglycaemia? Diabetes mellitus? Or both? Acta Cardiol. 2010;65:415–423. - PubMed
    1. Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B. et al. 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention: a report of the American College of Cardiology Foundation/ American Heart Association task force on practice guidelines and the society for cardiovascular angiography and interventions. Circulation. 2011;124(23):574–651. - PubMed
    1. Simes RJ, Topol EJ, Holmes DR Jr, White HD, Rutsch WR, Vahanian A. et al. Link between the angiographic sub study and mortality outcomes in a large randomized trial of myocardial reperfusion. Importance of early and complete infarct artery reperfusion. GUSTO-I investigators. Circulation. 1995;91:1923–1928. - PubMed
    1. Brener SJ, Mehran R, Dressler O, Cristea E, Stone GW. Diabetes mellitus, myocardial reperfusion, and outcome in patients with acute ST-elevation myocardial infarction treated with primary angioplasty (from HORIZONS AMI). Am J Cardiol. 2012;109:1111–1116. - PubMed

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