Comparison of Intracoronary and Intravenous Administration of High Dose Bolus Tirofiban in Patients of St Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Intracoronary and Intravenous Administration of High Dose Bolus Tirofiban

Authors

  • Muhamad Abbas Khan Department of Interventional Cardiology Hayatabad Medical Complex, Peshawar, Pakistan
  • Muhammad Salman Department of Interventional Cardiology Hayatabad Medical Complex, Peshawar, Pakistan
  • Saleem Ullah Department of Interventional Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
  • Mahmood Ul Hassan Department of Interventional Cardiology Hayatabad Medical Complex, Peshawar, Pakistan
  • Muhammad Abdul Wahab Hayatabad Medical Complex, Peshawar, Pakistan
  • Hamid Ali Shah Department of Interventional Cardiology Hayatabad Medical Complex, Peshawar, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v3i07.438

Keywords:

Coronary Intervention, Hypertension, Myocardial Infarction, Tirofiban bolus

Abstract

Acute ST-elevation myocardial infarction (STEMI) is a condition in which transmural myocardial ischemia causes myocardial necrosis and is the leading cause of death. Objectives: To compare the efficacy of tirofiban bolus administration via percutaneous coronary intervention (PCI) and intravenous route (IV) in STEMI patients for restoration of myocardial perfusion. Methods: A retrospective cross-sectional study was conducted at Cardiology Department, Hayatabad Medical Complex, Peshawar, during 2021-22. The study comprised 168 STEMI patients divided into Group A and B (n=84), treated with tirofiban PCI and IV route, respectively. Results: Incidence of STEMI was three folds higher in males than females, and the mean age of the patients was 55 years. Smoking and obesity were the potential risk factors. Patients in Group A had a better clinical outcome and prognosis than Group B. In comparison to the IV treatment group (91.66%), the ST-segment resolution time was considerably lower (P<0.05) in the PCI group (48.80%). In both groups, the observational parameters for TIMI flow grade, TIMI major and minor bleeding, MBG, and MACE were not-significantly different (P≥0.05), comprising percentages 94, 3.57, 9.52, 71.42, 5.95%, and 84.52, 2.38, 13.09, 75, 15.47%, respectively. In comparison to IV therapy group, the LVEF percentage in PCI group was statistically significant (P<0.05) after 24 hours and 30 days (57, 63 and 52, 58%, respectively). Conclusions: It was concluded that STEMI patients treated with PCI tirofiban bolus had significantly greater (p<0.05) recovery rates, left ventricular ejection fractions and better clinical outcomes than IV-treated group

References

Hanna EB and Glancy DL. ST-segment elevation: Differential diagnosis, caveats. Cleveland clinic journal of medicine. 2015; 82(6): 373-84. doi: 10.3949/ccjm.82a.14026

Parmar V, Singh I, Duggl K, Singh S. ST Elevation MI with Unknown Etiology: A Case Study. Clinics in Medicine. 2022 Aug; 4: 22-23.

Uddin M, Mir T, Khalil A, Mehar A, Gomez-Pineiro E, Babu MA, et al. ST-Elevation Myocardial Infarction Outcomes: A United States Nationwide Emergency Departments Cohort Study. The Journal of Emergency Medicine. 2022 Mar; 62(3): 306-15. doi: 10.1016/j.jemermed.2021.10.028

Smith SW, Khalil A, Henry TD, Rosas M, Chang RJ, Heller K, et al. Electrocardiographic differentiation of early repolarization from subtle anterior ST-segment elevation myocardial infarction. Annals of emergency medicine. 2012 Jul; 60(1): 45-56. doi: 10.1016/j.annemergmed.2012.02.015

Kontsevaya AV, Bates K, Schirmer H, Bobrova N, Leon D, McKee M. Management of patients with acute ST-segment elevation myocardial infarction in Russian hospitals adheres to international guidelines. Open heart. 2020 Jan; 7(1): 1-12 doi: 10.1136/openhrt-2019-001134

Hu S, Wang H, Zhu J, Li M, Li H, Gao D, et al. Effect of intra-coronary administration of tirofiban through aspiration catheter on patients over 60 years with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention. Medicine. 2018 May; 97(21): e10850. doi: 10.1097/MD.0000000000010850

Tang X, Li R, Ma L, Zhang T. Application of tirofiban in patients with acute myocardial infarction complicated with diabetes and undergoing emergency interventional therapy. Pakistan Journal of Medical Sciences. 2022 Jan; 38(1): 172-178. doi: 10.12669/pjms.38.1.4545

Wang H and Feng M. Influences of different dose of tirofiban for acute ST elevation myocardial infarction patients underwent percutaneous coronary intervention. Medicine. 2020 Jun; 99(23): e20402.doi: 10.1097/MD.0000000000020402

Hartman GD, Egbertson MS, Halczenko W, Laswell WL, Duggan ME, Smith RL, et al. Non-peptide fibrinogen receptor antagonists. 1. Discovery and design of exosite inhibitors. Journal of Medicinal Chemistry. 1992 Nov; 35(24): 4640-2. doi: 10.1021/jm00102a020

Van Drie JH. Computer-aided drug design: the next 20 years. Journal of Computer-Aided Molecular Design. 2007 Oct; 21(10): 591-601. doi: 10.1007/s10822-007-9142-y

Ghonim AA, Mostafa A, Emara A, Algazzar AS, Qutub MA. Clinical outcome of intracoronary versus intravenous high-dose bolus administration of tirofiban in diabetic patients undergoing primary percutaneous coronary intervention. South African Journal of Diabetes and Vascular Disease. 2019 Nov; 16(2): 76-80.

Žaliaduonytė-Pekšienė D, Lesauskaitė V, Liutkevičienė R, Tamakauskas V, Kviesulaitis V, Šinkūnaitė-Maršalkienė G, et al. Association of the genetic and traditional risk factors of ischaemic heart disease with STEMI and NSTEMI development. Journal of the Renin-Angiotensin-Aldosterone System. 2017 Nov; 18(4): 1-9.doi: 10.1177/1470320317739987

Moorthy N, Ramegowda KS, Jain S, Bharath G, Sinha A, Nanjappa MC, et al. Role of Angiotensin-Converting Enzyme (ACE) gene polymorphism and ACE activity in predicting outcome after acute myocardial infarction. IJC Heart & Vasculature. 2021 Feb; 32: 1-7. doi: 10.1016/j.ijcha.2020.100701

Kytö V, Sipilä J, Rautava P. Gender, age and risk of ST segment elevation myocardial infarction. European Journal of Clinical Investigation. 2014 Oct; 44(10): 902-9. doi: 10.1111/eci.12321

Steele L, Lloyd A, Fotheringham J, Sultan A, Iqbal J, Grech ED. A retrospective cross-sectional study on the association between tobacco smoking and incidence of ST-segment elevation myocardial infarction and cardiovascular risk factors. Postgraduate Medical Journal. 2015 Sep; 91(1079): 492-6. doi: 10.1136/postgradmedj-2015-133269

Toluey M, Ghaffari S, Tajlil A, Nasiri B, Rostami A. The impact of cigarette smoking on infarct location and in-hospital outcome following acute ST-elevation myocardial infarction. Journal of Cardiovascular and Thoracic Research. 2019; 11(3): 209-215. doi: 10.15171/jcvtr.2019.35

Maki KA, Ganesan SM, Meeks B, Farmer N, Kazmi N, Barb JJ, et al. The role of the oral microbiome in smoking-related cardiovascular risk: a review of the literature exploring mechanisms and pathways. Journal of Translational Medicine. 2022 Dec; 20(1): 1-26. doi: 10.1186/s12967-022-03785-x

Vintila V, Vintila A, Lungeanu LJ, Stuparu C, Vinerteanu D. Does hypertension associated to ST-elevation myocardial infarction population modify the expected evolution? Journal of Hypertension. 2019 Jul; 37: e115. doi: 10.1097/01.hjh.0000571492.81618.5a

Ali WM, Zubaid M, El-Menyar A, Mahmeed WA, Al-Lawati J, Singh R, et al. The prevalence and outcome of hypertension in patients with acute coronary syndrome in six Middle-Eastern countries. Blood pressure. 2011 Feb; 20(1): 20-6. doi: 10.3109/08037051.2010.518673

Guo Y-z, Zhao Z-w, Li S-m, Chen L-l. Clinical efficacy and safety of tirofiban combined with conventional dual antiplatelet therapy in ACS patients undergoing PCI. Scientific Reports. 2021 Aug; 11(1): 1-8. doi: 10.1038/s41598-021-96606-y

Osman M, Yassen I, Elhefny E. Comparison between intracoronary versus intravenous bolus injection of tirofiban on infarct size during primary PCI in patients with acute anterior ST segment elevation myocardial infarction. European Heart Journal. 2020 Nov; 41(2): 946. doi: 10.1093/ehjci/ehaa946.1437

Downloads

Published

2022-12-31
CITATION
DOI: 10.54393/pjhs.v3i07.438
Published: 2022-12-31

How to Cite

Abbas Khan, M. ., Salman, M. . ., Ullah, S. ., Ul Hassan, M. ., Abdul Wahab, M. ., & Ali Shah, H. . (2022). Comparison of Intracoronary and Intravenous Administration of High Dose Bolus Tirofiban in Patients of St Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: Intracoronary and Intravenous Administration of High Dose Bolus Tirofiban. Pakistan Journal of Health Sciences, 3(07), 185–189. https://doi.org/10.54393/pjhs.v3i07.438

Issue

Section

Original Article

Plaudit

Most read articles by the same author(s)