Efficacy and safety of single high-dose versus double high-dose intracoronary bolus tirofiban in patients with ST-segment elevation myocardial infarction

Year 2021, , 12 - 21, 04.01.2021

Mehmet Kaplan , İbrahim Halil Kurt , Alaa Quısı Gökhan Alıcı Şerafettin Demir Fethi Yavuz Yurdaer Dönmez

https://doi.org/10.18621/eurj.560531

Abstract

Objectives: We evaluated the efficacy and safety of single high-dose versus double high-dose intracoronary bolus tirofiban in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).

Methods: A total of 80 patients, who were admitted to our clinic and underwent primary PCI, were included in this observational cohort study. The patients were divided into the single high-dose group (n = 40) and the double high-dose group (n = 40) according to the intracoronary bolus tirofiban regime. The primary endpoint was assumed as the incidence of major adverse cardiac event (s) (MACE) defined as all-cause mortality and repeat coronary revascularization (target vessel revascularization [TVR]) at 30 days. MACE and bleeding events were evaluated at 7 and 30 days.

Results: The primary endpoint was not significantly different between the single and the double high-dose groups (40.0% vs. 17.5%, p = 0.994). However, a significantly lower 30-day TVR rate was observed in the double high-dose group (27.5% vs. 7.5%, p = 0.019). No significant difference was observed in terms of 30-day all-cause mortality between the two groups (12.5% vs. 10.0%, p = 0.712). Major bleeding events were not observed in any group. Multivariate logistic regression analysis demonstrated that CRUSADE score (Hazard ratio [HR]: 5.721; 95% CI: 2.036 to 16.073, p = 0.001) and platelet count (HR: 1.009; 95% CI: 1.000 to 1.018, p = 0.048) were the independent predictors of bleeding at 7 days.

Conclusions: Double high-dose intracoronary bolus tirofiban in STEMI patients undergoing primary PCI was associated with significantly lower 30-day TVR rates without an increase in bleeding events. However, it did not significantly affect MACE and all-cause mortality rates. 

Keywords

high-dose, glycoprotein IIb/IIIa receptor inhibitor, tirofiban, ST-segment elevation myocardial infarction, efficacy, safety

References

• 1. Meier P, Lansky AJ, Baumbach A. Almanac 2013: acute coronary syndromes. Heart 2013;99:1488-93.
• 2. Ward MJ, Kripalani S, Zhu Y, Storrow AB, Dittus RS, Harrell FE, Jr., et al. Incidence of emergency department visits for ST-elevation myocardial infarction in a recent six-year period in the United States. Am J Cardiol 2015;115:167-70.
• 3. Simes RJ, Topol EJ, Holmes DR, Jr., White HD, Rutsch WR, Vahanian A, et al. Link between the angiographic substudy and mortality outcomes in a large randomized trial of myocardial reperfusion. Importance of early and complete infarct artery reperfusion. GUSTO-I Investigators. Circulation 1995;91:1923-8.
• 4. Madan M, Berkowitz SD, Tcheng JE. Glycoprotein IIb/IIIa integrin blockade. Circulation 1998;98:2629-35.
• 5. Lynch JJ, Jr., Cook JJ, Sitko GR, Holahan MA, Ramjit DR, Mellott MJ, et al. Nonpeptide glycoprotein IIb/IIIa inhibitors. 5. Antithrombotic effects of MK-0383. J Pharmacol Exp Ther 1995;272:20-32.
• 6. Cutlip DE, Ricciardi MJ, Ling FS, Carrozza JP, Jr., Dua V, Garringer J, et al. Effect of tirofiban before primary angioplasty on initial coronary flow and early ST-segment resolution in patients with acute myocardial infarction. Am J Cardiol 2003;92:977-80.
• 7. De Luca G, Smit JJ, Ernst N, Suryapranata H, Ottervanger JP, Hoorntje JC, et al. Impact of adjunctive tirofiban administration on myocardial perfusion and mortality in patients undergoing primary angioplasty for ST-segment elevation myocardial infarction. Thromb Haemost 2005;93:820-3.
• 8. Shen J, Zhang Q, Zhang RY, Zhang JS, Hu J, Yang ZK, et al. Clinical benefits of adjunctive tirofiban therapy in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Coron Artery Dis 2008;19:271-7.
• 9. Kaymaz C, Keles N, Ozdemir N, Tanboga IH, Demircan HC, Can MM, et al. The effects of tirofiban infusion on clinical and angiographic outcomes of patients with STEMI undergoing primary PCI. Anatol J Cardiol 2015;15:899-906.
• 10. Valgimigli M, Percoco G, Malagutti P, Campo G, Ferrari F, Barbieri D, et al. Tirofiban and sirolimus-eluting stent vs abciximab and bare-metal stent for acute myocardial infarction: a randomized trial. JAMA 2005;293:2109-17.
• 11. Van't Hof AW, Ten Berg J, Heestermans T, Dill T, Funck RC, van Werkum W, et al. Prehospital initiation of tirofiban in patients with ST-elevation myocardial infarction undergoing primary angioplasty (On-TIME 2): a multicentre, double-blind, randomised controlled trial. Lancet 2008;372:537-46.
• 12. Ulus T, Senol U, Tahmazov S, Iskenderov K, Mutlu F, Cavusoglu Y. High-dose bolus tirofiban versus low-dose bolus in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Turk Kardiyol Dern Ars 2017;45:126-33.
• 13. Gibson CM, Jennings LK, Murphy SA, Lorenz DP, Giugliano RP, Harrington RA, et al. Association between platelet receptor occupancy after eptifibatide (integrilin) therapy and patency, myocardial perfusion, and ST-segment resolution among patients with ST-segment-elevation myocardial infarction: an INTEGRITI (Integrilin and Tenecteplase in Acute Myocardial Infarction) substudy. Circulation 2004;110:679-84.
• 14. Wu TG, Zhao Q, Huang WG, Wei JR, Chen SW, Zhao J, et al. Effect of intracoronary tirofiban in patients undergoing percutaneous coronary intervention for acute coronary syndrome. Circ J 2008;72:1605-9.
• 15. Kirma C, Erkol A, Pala S, Oduncu V, Dundar C, Izgi A, et al. Intracoronary bolus-only compared with intravenous bolus plus infusion of tirofiban application in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Catheter Cardiovasc Interv 2012;79:59-67.
• 16. Sorajja P, Gersh BJ, Costantini C, McLaughlin MG, Zimetbaum P, Cox DA, et al. Combined prognostic utility of ST-segment recovery and myocardial blush after primary percutaneous coronary intervention in acute myocardial infarction. Eur Heart J 2005;26:667-74.
• 17. Gibson CM, de Lemos JA, Murphy SA, Marble SJ, McCabe CH, Cannon CP, et al. Combination therapy with abciximab reduces angiographically evident thrombus in acute myocardial infarction: a TIMI 14 substudy. Circulation 2001;103:2550-4.
• 18. Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J, et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation 2011;123:2736-47.
• 19. Lincoff AM, Popma JJ, Ellis SG, Hacker JA, Topol EJ. Abrupt vessel closure complicating coronary angioplasty: clinical, angiographic and therapeutic profile. J Am Coll Cardiol 1992;19:926-35.
• 20. Willerson JT. Inhibitors of platelet glycoprotein IIb/IIIa receptors. Will they be useful when given chronically? Circulation 1996;94:866-8.
• 21. Scarborough RM, Kleiman NS, Phillips DR. Platelet glycoprotein IIb/IIIa antagonists. What are the relevant issues concerning their pharmacology and clinical use? Circulation 1999;100:437-44.
• 22. Peerlinck K, De Lepeleire I, Goldberg M, Farrell D, Barrett J, Hand E, et al. MK-383 (L-700,462), a selective nonpeptide platelet glycoprotein IIb/IIIa antagonist, is active in man. Circulation 1993;88:1512-7.
• 23. Ernst NM, Suryapranata H, Miedema K, Slingerland RJ, Ottervanger JP, Hoorntje JC, et al. Achieved platelet aggregation inhibition after different antiplatelet regimens during percutaneous coronary intervention for ST-segment elevation myocardial infarction. J Am Coll Cardiol 2004;44:1187-93.
• 24. Van Werkum JW, Gerritsen WB, Kelder JC, Hackeng CM, Ernst SM, Deneer VH, et al. Inhibition of platelet function by abciximab or high-dose tirofiban in patients with STEMI undergoing primary PCI: a randomised trial. Neth Heart J 2007;15:375-81.
• 25. Tang X, Li R, Jing Q, Liu Y, Liu P. Efficacy and Safety of Intracoronary versus Intravenous Administration of Tirofiban during Percutaneous Coronary Intervention for Acute Coronary Syndrome: A Meta-Analysis of Randomized Controlled Trials. PLoS One 2015;10:e0129718.
• 26. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018;39:119-77.
• 27. Budaj A, Brieger D, Steg PG, Goodman SG, Dabbous OH, Fox KA, et al. Global patterns of use of antithrombotic and antiplatelet therapies in patients with acute coronary syndromes: insights from the Global Registry of Acute Coronary Events (GRACE). Am Heart J 2003;146:999-1006.
• 28. Mandelzweig L, Battler A, Boyko V, Bueno H, Danchin N, Filippatos G, et al. The second Euro Heart Survey on acute coronary syndromes: characteristics, treatment, and outcome of patients with ACS in Europe and the Mediterranean Basin in 2004. Eur Heart J 2006;27:2285-93.
• 29. Schneider DJ, Herrmann HC, Lakkis N, Aguirre F, Wan Y, Aggarwal A, et al. Enhanced early inhibition of platelet aggregation with an increased bolus of tirofiban. Am J Cardiol 2002;90:1421-3.
• 30. De Luca G, Gibson CM, Bellandi F, Murphy S, Maioli M, Noc M, et al. Early glycoprotein IIb-IIIa inhibitors in primary angioplasty (EGYPT) cooperation: an individual patient data meta-analysis. Heart 2008;94:1548-58.
• 31. Ellis SG, Tendera M, de Belder MA, van Boven AJ, Widimsky P, Janssens L, et al. Facilitated PCI in patients with ST-elevation myocardial infarction. N Engl J Med 2008;358:2205-17.
• 32. Lee DP, Herity NA, Hiatt BL, Fearon WF, Rezaee M, Carter AJ, et al. Adjunctive platelet glycoprotein IIb/IIIa receptor inhibition with tirofiban before primary angioplasty improves angiographic outcomes: results of the TIrofiban Given in the Emergency Room before Primary Angioplasty (TIGER-PA) pilot trial. Circulation 2003;107:1497-501.
• 33. Rao SV, O'Grady K, Pieper KS, Granger CB, Newby LK, Van de Werf F, et al. Impact of bleeding severity on clinical outcomes among patients with acute coronary syndromes. Am J Cardiol 2005;96:1200-6.
• 34. Stone GW, Bertrand ME, Moses JW, Ohman EM, Lincoff AM, Ware JH, et al. Routine upstream initiation vs deferred selective use of glycoprotein IIb/IIIa inhibitors in acute coronary syndromes: the ACUITY Timing trial. JAMA 2007;297:591-602.