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Randomized Controlled Trial
. 2025 Aug;106(2):1187-1195.
doi: 10.1002/ccd.31665. Epub 2025 Jun 5.

Effect of Intracoronary Tirofiban Through Guiding Catheter Compared With Intracoronary Tirofiban Through Aspiration Catheter on the Microvascular Obstruction in Patients With STEMI Undergoing PCI: A Cardiac MR Study

Ahmed Mohamed Shawky Asfour  1 , Mohamed Osman Ibrahim  2 , Karim Salem Mashhour  2 , Ashraf Ahmed Abdel Megeed  3 , Akram Mohamed Abd El-Bary  2
Affiliations
Randomized Controlled Trial

Effect of Intracoronary Tirofiban Through Guiding Catheter Compared With Intracoronary Tirofiban Through Aspiration Catheter on the Microvascular Obstruction in Patients With STEMI Undergoing PCI: A Cardiac MR Study

Ahmed Mohamed Shawky Asfour et al. Catheter Cardiovasc Interv. 2025 Aug.

Abstract

Background: Myocardial infarction (MI) is a major global cause of morbidity and mortality. Reperfusion therapy in acute MI reduces mortality, but microvascular obstruction (MVO) may persist. Tirofiban improves myocardial perfusion by inhibiting platelet aggregation.

Aims: This study aims to compare intracoronary tirofiban delivery via guiding catheter versus aspiration catheter on MVO and myocardial salvage in ST-segment elevation MI (STEMI) patients undergoing PCI.

Methods: In this randomized study, 118 STEMI patients were classified into two groups: Group A (n = 56) received tirofiban via guiding catheter, and Group B (n = 62) via aspiration catheter. Cardiac MRI assessed MVO%, myocardial salvage index, and left ventricular function. Major adverse cardiovascular events (MACE) were monitored for 6 months.

Results: Patients receiving tirofiban via aspiration catheter had a significantly lower median MVO (0.8% vs. 2.5%, p < 0.001) and a higher myocardial salvage index (56.1% ± 8.1% vs. 44.8% ± 5.9%, p < 0.001) compared to the other group. No significant difference was reported between both groups regarding MACE (10.7 vs. 4.8, p = 0.305). Minor bleeding occurred at similar rates in both groups (10.7% vs. 9.7%, p = 0.852). Multivariate linear regression analysis confirmed that tirofiban administration via aspiration catheter was a significant predictor of reduced MVO% (B = -1.303, p < 0.001) and increased myocardial salvage index (B = 4.669, 95%, p = 0.001).

Conclusions: Intracoronary tirofiban delivery via aspiration catheter significantly reduces MVO and improves myocardial salvage in STEMI patients undergoing PCI compared to the guiding catheter method, without increasing the risk of bleeding or MACE.

Keywords: aspiration catheter; cardiac MRI; guiding catheter; microvascular obstruction; tirofiban.

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