Author + information
- Hakan Muhammed Taş1,
- Ziya Simsek1,
- Arif Ayan2,
- Ugur Aksu1,
- Selami Demirelli3,
- Zakir Lazoglu1,
- Yavuzer Koza1,
- Bedri Seven2,
- Mahmut Açıkel1 and
- Huseyin Senocak1
Background and Aim
Percutaneous coronary intervention (PCI) does not often have optimal results despite restoration of coronary blood flow at myocardial recovery because of impaired microvascular perfusion. Previous studies have focused on the starting time and dosage of tirofiban. This study aimed to investigate and evaluate with 99mTc-sestamibi scan whether the results of PCI can be changed by maintenance infusion of the tirofiban for 24 or 48 hours in patients presenting with anterior STEMI.
The study consisted of 84 patients with anterior STEMI who were candidates to undergo primary PCI and whose occlusion were in proximal or mid left anterior descending artery (LAD), were given 25μg/kg/3 minutes tirofiban and randomized maintenance infusion of 0.15μg/kg/minute for 24 or 48 hours. A resting 99mTc sestamibi scan was performed at post-procedure 5th day before discharge and the primary efficacy end point was a 5-point scoring system for perfusion defect severity. Major adverse cardiac events were defined as death from any cause, reinfarction, and clinically driven target-vessel revascularization within the first 6 months.
The baseline characteristics were similar at 24 (n=42) and 48 hours (n=42) infusion groups. There was no significant difference at the anticipated symptom onset to presentation time (3.83±2.09 h at 24 hour infusion group and 4.10±2.01 h at 48 hour infusion group, p=0.380) and door to balloon time (45.71±15.91 min. at 24 hour infusion group and 48.95±20.78 min. at 48 hour infusion group, p=0.542) between two groups. Except for basal anteroseptal and basal anterior segments, significant differences were obtained from the reduction of 5-point scoring system for perfusion defect severity in segments and in the summed rest scores (apex 2.90±0.95, 2.04±1.43; p<0.05; mid-anterior 1.88±0.94, 1.28±1.13; p<0.05; mid-anteroseptal 2.28±0.83, 1.73±1.14; p<0.05; apical anterior 2.69±0.81, 2.00±1.43; p<0.05;, apical septal 2.64±0.87, 1.95±1.32; p<0.05;, apical lateral 2.50±0.94, 2.21±1.27; p<0.05, basal anterior 0.11±0.32, 0.33±0.75; p=0.09; basal anteroseptal 0.66±0.72, 0.50±0.91; p=0.288, SRS 15.61±4.60, 11.97±7.34; p<0.05). No significant effect was observed on major adverse cardiac events at 6 months. The safety profile did not differ between 24 and 48 hour infusion of tirofiban.
The use of tirofiban, when administered at a high dose of bolus and maintained for 48 hours, is safe and significantly reduces perfusion defect severity in patients with anterior STEMI presenting early after symptom onset and undergoing primary PCI.
|24 hour tirofiban maintenance||48 hour tirofiban maintenance||p Value|
|Male Sex||37 (88%)||34 (80%)||0.612|
|Diabetes Mellitus||7 (16%)||5 (12%)||0.764|
|Hypertension||15 (35%)||12 (29%)||0.712|
|Smoking||23 (54%)||24 (57%)||0.762|
|Symptom onset to hospital arrival (hour)||3.83±2.09||4.10±2.01||0.380|
|Door to balloon time (minute)||45.71±15.91||50.95±35.78||0.542|
|Reference Vessel Diameter||3.27±0.34||3.46±0.38||0.201|
|5 point scoring system for perfusion defect severity|
|Summed Rest Score||15.61±4.60||11.97±7.34||<0.05|
Baseline characteristics and 5 point scoring system for perfusion defect severity results of anterior STEMI patients