Objective: This prospective study was conducted to investigate the clinical outcomes and safety of primary percutaneous coronary intervention (PCI) combined with tirofiban therapy in patients with acute ST-segment elevation myocardial infarction (STEMI).
Methods: One hundred and sixty consecutive patients with acute STEMI were randomly allocated to either primary PCI combined with tirofiban therapy (Tirofiban group, n = 80) or primary PCI treatment alone (Control group, n = 80). Baseline characteristics, PCI features and clinical outcomes during hospitalization were compared between the two groups. Left ventricular ejection fraction (LVEF) and major adverse cardiac events (MACE, including death, re-infarction and target vessel revascularization) at 30 and 180 days after discharge were also compared.
Results: The baseline clinical characteristics were comparable between the two groups. Despite similar TIMI grade 3 flow (95% vs. 87.5%, P > 0.05) between the tirofiban and control groups immediately after the procedure, TMP grade 3 (75% vs. 56.3%, P < 0.05), corrected TIMI frame count (cTFC, 23.56 +/- 5.19 vs. 31.05 +/- 6.92, P < 0.01), resolution of sum of ST-segment elevation (6.51 +/- 3.56 mm vs. 4.53 +/- 2.47 mm, P < 0.01), peak value of CK-MB (225.02 +/- 105.81 microg/L vs. 269.20 +/- 110.88 microg/L, P < 0.05) and TnI (45.25 +/- 33.00 microg/L vs. 56.46 +/- 29.48 microg/L, P < 0.05) in tirofiban group were significantly superior to the control group related to a shorter hospital stay (11.38 +/- 4.63 days vs. 14.68 +/- 6.90 days, P < 0.01). Compared to control group, the MACE rates at 30 days (5.0% vs. 16.3%, P < 0.05) and 180 days (7.5% vs. 18.8%, P < 0.05) were also significantly reduced and LVEF was significantly improved (30 days: 53% +/- 7% vs. 49% +/- 9%, P < 0.01; 180 days: 59% +/- 8% vs. 53% +/- 9%, P < 0.01) in tirofiban group. Multivariate logistic analysis revealed that age > 65 years (OR = 3.42, P < 0.01), tirofiban therapy (OR = 0.56, P < 0.05) and LVEF < 0.5 during hospitalization (OR = 2.56, P < 0.01) were independent predictors of MACE rates at 180 days follow up. There was no significant difference in hemorrhagic complications between the two groups (16.3% vs. 7.5%, P > 0.05).
Conclusion: Adjunctive therapy with tirofiban for patients with acute STEMI who undergo primary PCI is safe and can significantly improve re-perfusion in the infarct area and clinical outcomes at 30 as well as 180 days after procedure.