Comparison of Intracoronary Tirofiban And Intravenous Tirofiban for Major Adverse Cardiac Events and Cerebrovascular Accident
Comparison of Intracoronary Tirofiban and Intravenous Tirofiban
DOI:
https://doi.org/10.54393/pjhs.v4i11.1149Keywords:
Myocardial Infarction, Cerebrovascular Accident, Revascularization, TirofibanAbstract
Major Adverse Cardiovascular Events (MACE) and and Cerebrovascular Accidents (CVA) have become primary areas of interest due to the ongoing focal research in cardiovascular diseases. Objective: To assess the frequency of major adverse cardiac events and cerebrovascular accidents for intracoronary tirofiban and intravenous tirofiban. Methods: It was a comparative study conducted at the Punjab Institute of Cardiology, Lahore from March 2019 to March 2020. A total of 250 patients of both genders, aged between 20 to 65 years were enrolled in this study who had STEMI and have high thrombus burden or TIMI flow grade < 3 during primary PCI. They were divided into two groups namely intracoronary tirofiban group and intravenous tirofiban. The impact of intracoronary tirofiban versus intravenous tirofiban outcomes were assessed. Results: Statistically insignificant difference in MACE (myocardial infarction, cerebrovascular accident & revascularization) between intracoronary & intravenous tirofiban groups was noted. The frequency distribution for cerebrovascular accidents (CVA) showed that haemorrhage was found similar in both groups. Ischemic stroke, in patients of the intracoronary tirofiban group compared with intravenous tirofiban group, was 1 (0.8%) vs 3 (2.4%) with p-value 0.348 respectively. Reversible ischemic neurological deficit (RIND) was found in 3 (2.4%) in the intracoronary and 4 (3.2%) in the intravenous group. Transient ischemic attack (TIA) found in the intracoronary was 8(6.4%) whereas in the intravenous group was 9 (7.2%). Conclusions: The results of our study make us conclude that tirofiban when given intracoronary or intravenous does not show any significant difference for major adverse cardiac events and cerebrovascular accidents.
References
Gal D, Thijs B, Glänzel W, Sipido KR. Hot topics and trends in Cardiovascular Research. European Heart Journal. 2019 Jul; 40(28): 2363–74. doi:10.1093/eurheartj/ehz282. DOI: https://doi.org/10.1093/eurheartj/ehz282
Sharma A, Pagidipati NJ, Califf RM, McGuire DK, Green JB, Demets D et al. Impact of regulatory guidance on evaluating cardiovascular risk of new glucose-lowering therapies to treat type 2 diabetes mellitus. Circulation. 2020 Mar; 141(10): 843–62. doi:10.1161/circulationaha.119.041022. DOI: https://doi.org/10.1161/CIRCULATIONAHA.119.041022
Marx N, McGuire DK, Perkovic V, Woerle HJ, 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 Sep;40(9):1144–51. doi:10.2337/dc17-0068. DOI: https://doi.org/10.2337/dc17-0068
Gavrielov-Yusim N and Friger M. Use of administrative medical databases in population-based research: Table 1. Journal of Epidemiology and Community Health. 2013 Mar; 68(3): 283–7. doi:10.1136/jech-2013-202744. DOI: https://doi.org/10.1136/jech-2013-202744
Lieschke F, Zheng Y, Schaefer JH, van Leyen K, Foerch C. Measurement of platelet function in an experimental stroke model with aspirin and clopidogrel treatment. Frontiers in Neurology. 2020 Feb; 11. doi:10.3389/fneur.2020.00085. DOI: https://doi.org/10.3389/fneur.2020.00085
Lam L. Flow cytometric analysis of intra-platelet VASP for evaluation of clopidogrel resistance in ischemic heart disease patients undergoing percutaneous coronary intervention. HKU Theses Online (HKUTO). 2012. doi:10.5353/th_b4842120. DOI: https://doi.org/10.5353/th_b4842120
Tang X and Li R. Comparison of intracoronary versus intravneous tirofiban in acute STEMI patients undergoing primary PCI. Research Square. 2021 Dec; doi:10.21203/rs.3.rs-1081547/v1. DOI: https://doi.org/10.21203/rs.3.rs-1081547/v1
Kang DH and Park J. Endovascular stroke therapy focused on stent retriever thrombectomy and direct clot aspiration: Historical Review and modern application. Journal of Korean Neurosurgical Society. 2017 May; 60(3): 335–47. doi:10.3340/jkns.2016.0809.005. DOI: https://doi.org/10.3340/jkns.2016.0809.005
Bernsen ML, Goldhoorn RJ, 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 Jan;52(1):80-90.
Neumann FJ. Glycoprotein iib/iiia receptor blockade in myocardial infarction: Adjunctive therapy to percutaneous coronary interventions. Platelet Glycoprotein IIb/IIIa Inhibitors in Cardiovascular Disease. Totowa, NJ: Humana Press. 2003: 275–87. doi:10.1385/1-59259-376-3:275. DOI: https://doi.org/10.1385/1-59259-376-3:275
Balghith M. High bolus tirofiban vs abciximab in acute STEMI patients undergoing primary PCI - the TAMIP study. Heart Views: The Official Journal of the Gulf Heart Association. 2012 Jul; 13(3): 85. doi:10.4103/1995-705x.102145. DOI: https://doi.org/10.4103/1995-705X.102145
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 Oct; 129(3): 379–87. doi:10.1016/j.ijcard.2007.07.127. DOI: https://doi.org/10.1016/j.ijcard.2007.07.127
Fitts J, Ver Lee P, Hofmaster P, Malenka D. Fluoroscopy‐guided femoral artery puncture reduces the risk of pci‐related vascular complications. Journal of Interventional Cardiology. 2008 Jun; 21(3): 273–8. doi:10.1111/j.1540- 8183.2008.00351.x. DOI: https://doi.org/10.1111/j.1540-8183.2008.00351.x
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 Nov 6; 148(Suppl_1): A17921.
Coller BS. Glycoprotein iib/iiia antagonists: Development of abciximab and pharmacology of abciximab, Tirofiban, and Eptifibatide. Platelet Glycoprotein IIb/IIIa Inhibitors in Cardiovascular Disease. Totowa, NJ: Humana Press. 203 :073–101. doi:10.1385/1-59259-376-3:073. DOI: https://doi.org/10.1385/1-59259-376-3:073
Anandan PK, Tamilarasu K, Rajendran G, Sundaram S, Ramasamy P, Vidyakar RB. Thrombus aspiration plus intracoronary abciximab vs intracoronary abciximab alone in patients with STEMI undergoing primary PCI. Cardiology and Angiology: An International Journal. 2019 Nov; 8(4): 1–10. doi:10.9734/ca/2019/v8i430120. DOI: https://doi.org/10.9734/ca/2019/v8i430120
Andre P and Phillips DR. Glycoprotein iib/iiia in platelet aggregation and acute arterial thrombosis. Platelet Glycoprotein IIb/IIIa Inhibitors in Cardiovascular Disease. Totowa, NJ: Humana Press. 2003 :039–71. doi:10.1385/1-59259-376-3:039. DOI: https://doi.org/10.1385/1-59259-376-3:039
Lago IM, Novaes GC, Badran AV, Pavão RB, Barbosa R, Figueiredo GL et al. In-lab upfront use of Tirofiban may reduce the occurrence of no-reflow during primary percutaneous coronary intervention. A pilot randomized study. Arquivos Brasileiros de Cardiologia. 2016 Nov; 403-10.107(5): 403-10. doi:10.5935/abc.20160149. DOI: https://doi.org/10.5935/abc.20160149
Savonitto S, De Luca G, Goldstein P, van t’ Hof A, Zeymer U, Morici N et al. Antithrombotic therapy before, during and after emergency angioplasty for ST Elevation Myocardial Infarction. European Heart Journal: Acute Cardiovascular Care. 2016 Mar; 6(2): 173–90. doi:10.1177/2048872615590148. DOI: https://doi.org/10.1177/2048872615590148
Sun B, Liu Z, Yin H, Wang T, Chen T, Yang S et al. Intralesional versus intracoronary administration of glycoprotein iib/iiia inhibitors during percutaneous coronary intervention in patients with acute coronary syndromes. Medicine. 2017 Oct; 96(40). doi:10.1097/md.0000000000008223. DOI: https://doi.org/10.1097/MD.0000000000008223
Elbadawi A, Elgendy IY, Megaly M, Ha LD, Mahmoud K, Alotaki E et al. Meta-analysis of randomized trials of intracoronary versus intravenous glycoprotein iib/iiia inhibitors in patients with st-elevation myocardial infarction undergoing primary percutaneous coronary intervention. The American Journal of Cardiology. 2017 Oct; 120(7): 1055–61. doi:10.1016/j.amjcard.2017.06.040. DOI: https://doi.org/10.1016/j.amjcard.2017.06.040
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. Coronary Artery Disease. 2008 Jun; 19(4): 271-7. doi: 10.1097/MCA.0b013e3282f487e0. DOI: https://doi.org/10.1097/MCA.0b013e3282f487e0
Wilmer CI. Intracoronary high-dose bolus tirofiban administration during complex coronary interventions: A United States-based case series. Cardiovascular Revascularization Medicine. 2018 Jan; 19(1): 112–6. doi:10.1016/j.carrev.2017.06.009. DOI: https://doi.org/10.1016/j.carrev.2017.06.009
Zaki TM, Gamal A, El Hamady WA, Mansour S, Abu Arab TM. Comparison between the effect of intracoronary bolus of tirofiban versus EPTIFIBATIDE as adjunctive antiplatelet therapy on the outcome of primary coronary intervention in patients with acute anterior ST segment elevation myocardial infarction. The Egyptian Heart Journal. 2011 Jun; 63(2): 109–15. doi:10.1016/j.ehj.2011.09.002. DOI: https://doi.org/10.1016/j.ehj.2011.09.002
Ma Q, Ma Y, Wang X, Li S, Yu T, Duan W et al. Intracoronary compared with intravenous bolus tirofiban on the microvascular obstruction in patients with STEMI undergoing PCI: A cardiac MR study. The International Journal of Cardiovascular Imaging. 2020 Jun; 36(6): 1121–32. doi:10.1007/s10554-020-01800-0. DOI: https://doi.org/10.1007/s10554-020-01800-0
Zhao XM, Gao CY, Chu YJ, Yang L, Yang XZ, Xu WK et al. Fondaparinux vs. enoxaparin in patients with non-ST elevation acute coronary syndromes (NSTE-ACS) treated with percutaneous coronary intervention and tirofiban: An exploratory study in China. Journal of Clinical Pharmacy and Therapeutics. 2015 Oct; 40(5): 584–9. doi:10.1111/jcpt.12315. DOI: https://doi.org/10.1111/jcpt.12315
Liu X, Dong P, Xing S, Wang H, Li Z, Zhang H et al. Clinical evaluation of thrombus aspiration combined with tirofiban in patients with acute myocardial infarction with elective percutaneous coronary intervention. Journal of International Medical Research. 2013 Oct; 41(5): 1532–40. doi:10.1177/0300060513480915. DOI: https://doi.org/10.1177/0300060513480915
Zhangjin D. GW25-E0788 the effect of thrombus-aspiration combined tirofiban in the patients with ST-segment elevation myocardial infraction (STEMI) after the direct percutaneous coronary intervention. Journal of the American College of Cardiology. 2014 Oct; 64(16). C144. doi:10.1016/j.jacc.2014.06.663. DOI: https://doi.org/10.1016/j.jacc.2014.06.663
Watanabe H, Shiomi H, Nakatsuma K, Morimoto T, Taniguchi T, Furukawa Y et al. Clinical efficacy of thrombus aspiration on 5‐year clinical outcomes in patients with ST‐segment elevation acute myocardial infarction undergoing percutaneous coronary intervention. Journal of the American Heart Association. 2015 Jun; 4(11). e001962. doi:10.1161/jaha.115.001945. DOI: https://doi.org/10.1161/JAHA.115.001945
Hsin HT, Wu CF, Liao PC, Lin PC, Chen LY. Upstream tirofiban reduces reperfusion cardiac arrhythmias in patients of acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. International journal of cardiology. 2011 Jan; 146(2): 292-4. doi:10.1016/j.ijcard.2010.10.088. DOI: https://doi.org/10.1016/j.ijcard.2010.10.088
Wang H and Feng M. Influences of different dose of Tirofiban for acute ST elevation myocardial infarction patients underwent percutaneous coronary intervention. Medicine. 2020;99(23). doi:10.1097/md.0000000000020402. DOI: https://doi.org/10.1097/MD.0000000000020402
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