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. 2021 Jan;25(1):7-16.
doi: 10.14744/AnatolJCardiol.2020.99469.

A meta-analysis of randomized controlled trials investigating tirofiban combined with conventional drugs by intracoronary administration for no-reflow prevention

Qian Zeng  1 , Long-Dan Zhang  1 , Wei Wang  1
Affiliations

A meta-analysis of randomized controlled trials investigating tirofiban combined with conventional drugs by intracoronary administration for no-reflow prevention

Qian Zeng et al. Anatol J Cardiol. 2021 Jan.

Abstract

Objective: Studies examining the effects of tirofiban combined with other conventional drugs for treating patients with acute coronary syndrome (ACS) are lacking. Thus, in this study, we conducted a meta-analysis investigating both the safety and efficacy of intracoronary (IC) administration of tirofiban treatment alone versus in combination with other conventional treatments for the no-reflow phenomenon (NRP) during percutaneous coronary intervention (PCI) in patients with ACS.

Methods: PubMed, Cochrane Library, Embase, Chinese Biomedical (CBM), Google Scholar, and China National Knowledge Infrastructure (CNKI) databases were searched for randomized controlled trials (RCTs) that included data comparing tirofiban treatment alone versus in combination with other conventional therapies. Two independent reviewers evaluated the quality of all data and studies were evaluated according to the Cochrane Collaboration Handbook 5.3.

Results: Thirteen RCTs involving 937 patients were included in our analysis. Tirofiban plus conventional drug treatment improved thrombolysis in myocardial infarction (TIMI) grade 3 flow (OR: 0.18; 95% CI: 0.11–0.30; p<0.01), corrected TIMI frame count (CTFC) (WMD: 6.61; 95% CI: 4.69–8.53; p<0.01), and corrected left ventricular ejection fraction (LVEF) (WMD: −3.76; 95% CI: −4.70 to −2.82; p<0.01) and reduced major adverse cardiovascular events (MACE) (OR: 3.9; 95% CI; 2.51–6.07; p<0.01). Tirofiban plus conventional therapy reduced bleeding; however, no statistical significance was observed (OR: 1.24; 95% CI: 0.50–3.12; p=0.64).

Conclusion: IC administration of tirofiban combined with conventional drugs is more effective than tirofiban treatment alone for no-reflow (NR) during PCI without increasing bleeding events. This combination is recommended as an optimal strategy for preventing NR.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Assessment of bias of the studies included Red - high risk; yellow - unclear risk; green - low risk
Figure 2
Figure 2
PRISMA flowchart
Figure 3
Figure 3
Forest plots comparing thrombolysis in myocardial infarction (TIMI) flow transformation
Figure 4
Figure 4
Forest plots comparing corrected TIMI frame count
Figure 5
Figure 5
Forest plots comparing major adverse cardiovascular events
Figure 6
Figure 6
Forest plots comparing left ventricular ejection fraction
Figure 7
Figure 7
Forest plots comparing bleeding events
See this image and copyright information in PMC

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