Korean Circ J.  2005 May;35(5):362-368. 10.4070/kcj.2005.35.5.362.

The Effect of Primary Percutaneous Coronary Intervention after the Administration of Tirofiban Alone or Tirofiban Combined with Low dose Alteplase in Patients with Acute Myocardial Infarction on ST Elevation Resolution, TIMI Flow and Short-Term Clinical Outcomes

• Kim SP
• Cho JH
• Chae DR
• Yeom SM
• Jeon WJ
• Kim SH
• O YS
• Yang HS
• Kim DH
• Bae Y
• Kim JY
• Jeong MH

• KMID: 2227141
• DOI: http://doi.org/10.4070/kcj.2005.35.5.362

Abstract

BACKGROUND AND OBJECTIVES
The combination of platelet glycoprotein IIb/IIIa inhibitors and a low dose thrombolytic agent may produce early Thrombolysis In Myocardial Infarction (TIMI) 3 flow and a high rate of ST elevation resolution in an ST elevation acute myocardial infarction (STEMI). The clinical effect of tirofiban combined with low dose alteplase, prior to primary percutaneous coronary intervention (PCI) in STEMI, were evaluated on the ST elevation resolution, TIMI flow and 30-day clinical outcomes.
SUBJECTS AND METHODS
Following aspirin, clopidogrel and standard heparin, 45 patients with STEMI were randomized into 2 groups; tirofiban administration (Group I; n=23, 64+/-10 years; 15 male) or combined administration of tirofiban with 40 mg alteplase prior to primary PCI (Group II; n=22, 59+/-11 years; 19 male). The pre- and post-interventional TIMI flow grades, ST elevation resolution and bleeding complications were compared between the two groups. The major adverse cardiac events (MACE) were compared between the two groups during 30-days of clinical follow-up.
RESULTS
Group II had a higher pre-interventional TIMI flow (TIMI flow> or =2: 34.8% vs. 90.9%, p<0.0001) and rate of ST elevation resolution (49.0+/-27.8% vs. 66.6+/-27.2%, p=0.045) than Group I. A major bleeding complication developed in 1 (5.0%) Group II patient, and minor bleeding complications developed 1 patient from each group (Group I; 9.5% vs. Group II; 10%, p=0.959).
CONCLUSION
Combined administration of tirofiban with alteplase prior to primary PCI leads to a higher TIMI flow and more frequent ST elevation resolution, without bleeding complications, compared to a single administration of tirofiban.

Keyword

Myocardial infarction; Angioplasty; Thrombolysis, therapeutic; Electrocardiography

MeSH Terms

Angioplasty
Aspirin
Blood Platelets
Electrocardiography
Follow-Up Studies
Glycoproteins
Hemorrhage
Heparin
Humans
Myocardial Infarction*
Percutaneous Coronary Intervention*
Thrombolytic Therapy
Tissue Plasminogen Activator*
Aspirin
Glycoproteins
Heparin
Tissue Plasminogen Activator