COMPARISON OF INTRAVENOUS TIROBAN AND INTRACORONARY TIRO BAN IN TERMS OF ADVERSE CARDIAC EVENTS AND CEREBROVASCULAR ACCIDENTS

T AMTAL; SA KHAN; B BIBI; J ASHRAF; M RAHMAN; KA NAQVI

doi:10.54112/bcsrj.v2024i1.1276

Authors

T AMTAL Pakistan Institute of Medical Sciences, Pakistan
SA KHAN Rehman Medical Institute, Pakistan
B BIBI Hayatabad Medical Complex, Pakistan
J ASHRAF Karachi Institute of Medical Sciences (KIMS), Malir, Pakistan
M RAHMAN Hayatabad Medical Complex, Pakistan
KA NAQVI Combined Military Hospital Malir Cantt, Karachi, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2024i1.1276

Keywords:

Tirofiban, intracoronary, intravenous, percutaneous coronary intervention, myocardial infarction, revascularization, cerebrovascular events, randomized controlled trial

Abstract

Patients with acute coronary syndrome (ACS) and a high thrombus burden undergoing percutaneous coronary intervention (PCI) are at risk for major adverse cardiac events (MACE) and cerebrovascular complications. Tirofiban, a glycoprotein IIb/IIIa inhibitor, is used to reduce thrombus burden, with administration routes (intracoronary vs. intravenous) potentially influencing outcomes. Limited data exist comparing the effects of intracoronary and intravenous administration of tirofiban on adverse cardiac and cerebrovascular events in these high-risk patients Objective: To compare intravenous tiroban and intracoronary tiroban in terms of adverse cardiac events and cerebrovascular accidents. Methods: A randomized controlled trial was conducted on eighty patients aged ≥ 40 years with ACS and high thrombus burden scheduled for PCI were randomized, with 40 patients receiving intracoronary tirofiban (Group A) and 40 receiving intravenous tirofiban (Group B). Group A received a bolus of tirofiban (10 µg/kg) directly at the thrombus site during PCI, followed by a 24-hour intravenous infusion (0.15 µg/kg/min). Group B received the same bolus dose intravenously, followed by an identical infusion protocol. MACE and cerebrovascular accidents were compared in both groups. Results: MI occurred in 5 patients (12.5%) in Group A while 6 patients (15.0%) in Group B (p=0.74). Repeat revascularization was required in 8 patients (20.0%) in Group A and 5 patients (12.5%) in Group B (p=0.36). Cerebrovascular events occurred in 4 patients (10.0%) in Group A and 7 patients (17.5%) in Group B (p=0.33). Conclusion: Both intracoronary and intravenous tirofiban administration result in comparable outcomes regarding MACE and cerebrovascular events in patients undergoing PCI with a high thrombus burden.

Downloads

Download data is not yet available.

References

Bergmark BA, Mathenge N, Merlini PA, Lawrence-Wright MB, Giugliano RP. Acute coronary syndromes. The Lancet. 2022;399(10332):1347-58.

Marx N, McGuire DK, Perkovic V, Woerle H-J, Broedl UC, Von Eynatten M, et al. Composite primary end points in cardiovascular outcomes trials involving type 2 diabetes patients: should unstable angina be included in the primary end point? Diabetes Care. 2017;40(9):1144-51.

Gavrielov-Yusim N, Friger M. Use of administrative medical databases in population-based research. J Epidemiol Community Health. 2014;68(3):283-7.

Bernsen MLE, Goldhoorn R-JB, Lingsma HF, Van Oostenbrugge RJ, Van Zwam WH, Uyttenboogaart M, et al. Importance of occlusion site for thrombectomy technique in stroke: comparison between aspiration and stent retriever. Stroke. 2021;52(1):80-90.

Neumann F-J. Glycoprotein IIb/IIIa Receptor Blockade in Myocardial Infarction: Adjunctive Therapy to Percutaneous Coronary Interventions. Platelet Glycoprotein IIb/IIIa Inhibitors in Cardiovascular Disease: Springer; 2003. p. 275-87.

Balghith MA. High bolus tirofiban vs abciximab in acute STEMI patients undergoing primary PCI-The Tamip study. Heart Views. 2012;13(3):85-90.

Montalescot G, Öngen Z, Guindy R, Sousa A, Lu S-Z, Pahlajani D, et al. Predictors of outcome in patients undergoing PCI. Results of the RIVIERA study. International journal of cardiology. 2008;129(3):379-87.

Collet C, Munhoz D, Mizukami T, Sonck J, Matsuo H, Shinke T, et al. Influence of Pathophysiologic Patterns of Coronary Artery Disease on Immediate Percutaneous Coronary Intervention Outcomes. Circulation. 2024;150(8):586-97.

Upreti P, Saad M, Pandey N, Krim NR, Vittorio T. Diastolic Dysfunction Might Predict Outcomes in Acute Coronary Syndrome Patients Undergoing Primary Percutaneous Coronary Intervention. Circulation. 2023;148(Suppl_1):A17921-A.

Coller BS. Glycoprotein IIb/IIIa Antagonists: Development of Abciximab and Pharmacology of Abciximab, Tirofiban, and Eptifibatide. Platelet Glycoprotein IIb/IIIa Inhibitors in Cardiovascular Disease: Springer; 2003. p. 73-101.

Bukhari SHR, Rana MA, Mirza MS, Kazmi MN, Rehman ZU, Din JSU. Comparison of Intracoronary Tirofiban And Intravenous Tirofiban for Major Adverse Cardiac Events and Cerebrovascular Accident: Comparison of Intracoronary Tirofiban and Intravenous Tirofiban. Pakistan Journal of Health Sciences. 2023:153-8.

Tang X, Li R, Zhang T. Comparison of intracoronary versus intravenous tirofiban in acute ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. Coronary Artery Disease. 2022;33(7):547-52.