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Sharma YP, Batta A, Rambabu E, Jaiswal B, Bhogal S, Gupta H, Mehrotra S, Panda P. [Efficacité du tirofiban intracoronaire avant pose d'un stent suivi d'une perfusion dans une charge de thrombus importante prouvée par angiographie : une étude randomisée]. Ann Cardiol Angeiol (Paris) 2023; 72:101609. [PMID: 37270883 DOI: 10.1016/j.ancard.2023.101609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/22/2023] [Accepted: 05/10/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND The presence of angiographic thrombus is associated with poor outcomes in contemporary cardiology practice. Percutaneous coronary intervention (PCI) in such lesions is associated with slow flow and no-reflow phenomenon which translate into poor clinical outcomes. METHODS This was a single-centre, prospective, open-label, randomized controlled study with 50 patients each in intervention group and control group. Patients with angiographically proven large thrombus burden were recruited. In the intervention group, patients were given loading dose of intracoronary tirofiban (25 mcg/kg infused over 5 minutes) followed by prolonged infusion of tirofiban (0.15 mcg/kg/min for 12-18 hours) followed by PCI after 48-72 hours interval. In control group patients were taken up directly for PCI during the index procedure. Outcomes were assessed angiographically and in terms of clinical endpoints. RESULTS The primary composite-endpoint of recurrent angina, myocardial infarction, cardiovascular death, target lesion revascularization and unscheduled CABG was significantly lower in the intervention arm compared to control arm (4% vs 16%, p = 0.04). Amongst the secondary endpoints, a statistically significant 30-day increase in ejection fraction from baseline was observed in the intervention group compared to the control group (1.6 ± 1.3 vs 0.2 ± 0.4, p = 0.0001). Overall mortality was similar in the two groups (4% vs 8%, p = 0.39). The primary safety endpoint of major bleeding was also similar in the 2 groups (2% vs 0%, p = 0.31). CONCLUSIONS Tirofiban use prior to PCI in high thrombus burden was associated with improved clinical and angiographic endpoints with similar adverse events compared to controls.
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Affiliation(s)
- Yash Paul Sharma
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh-160012, India
| | - Akash Batta
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, 141001, India
| | - Eslavath Rambabu
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh-160012, India
| | - Bhavuk Jaiswal
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, 141001, India
| | - Sukhdeep Bhogal
- Department of Interventional Cardiology, MedStar Washington Hospital Centre, 110 Irving St. Suite 4B-1, Washington, NWDC, 20010, USA
| | - Himanshu Gupta
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh-160012, India
| | - Saurabh Mehrotra
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh-160012, India
| | - Prashant Panda
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh-160012, India.
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Mahtta D, Bavry AA. αIIbβ3 (GPIIb-IIIa) Antagonists. Platelets 2019. [DOI: 10.1016/b978-0-12-813456-6.00052-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ajlani B, Gibault-Genty G, Cherif G, Blicq E, Azzaz S, Schiano P, Brami M, Sarfati L, Charbonnel C, Convers-Domart R, Livarek B, Georges JL. [Intracoronary administration of antithrombotic agents via a perfusion balloon catheter in patients with ST-segment elevation myocardial infarction presenting with massive intraluminal thrombus and failed aspiration]. Ann Cardiol Angeiol (Paris) 2016; 65:299-305. [PMID: 27693166 DOI: 10.1016/j.ancard.2016.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 09/02/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Massive intracoronary thrombus is associated with adverse procedural results including failed aspiration and unfavourable reperfusion. We aim to evaluate the effect of the intracoronary administration of antithrombotic agents via a perfusion catheter in patients with ST-segment elevation myocardial infarction (STEMI) presenting with a large thrombus burden and failed aspiration. METHODS We retrospectively analyzed the thrombus burden, the TIMI grade flow, and the myocardial Blush in 25 consecutive STEMI patients with a large thrombus burden and failed manual aspiration, who received intracoronary infusion of glycoprotein IIb/IIIa inhibitors (N=17) or bivalirudine (N=8) via a 6F-infusion catheter (ClearWay™ RX) RESULTS: Mean age was 67±14 years, 16 patients (64 %) presented with anterior STEMI, and 7 (28 %) with cardiogenic shock. Immediately after intracoronary infusion, the TIMI flow grade improved of 2 grades in 7 patients (28 %), and 1 grade in 14 (56 %), a complete resolution of the thrombus was observed in 9 patients, and a >50 % resolution in 12. Blush was improved of 3 grades in 15 patients (60 %), of 2 grades in 7 (28 %), and Blush grade 0 remained in 3. At the end of procedure, we observed normal TIMI 3flow in most patients (92 %), a complete resolution of thrombus in 80 %, and a Blush grade 3 in 68 %. CONCLUSIONS In STEMI patients presenting with a large thrombus burden and failed aspiration, intracoronary administration of glycoprotein IIb/IIIa inhibitors or bivalirudin via the perfusion catheter ClearWay™ RX significantly reduced the thrombus burden and improved the TIMI flow and the Blush grade, without bleeding.
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Affiliation(s)
- B Ajlani
- Service de cardiologie, unité de soins intensif cardiologiques et cardiologie interventionnelle, centre hospitalier de Versailles, hôpital André-Mignot, 177, rue de Versailles, 78150 Le Chesnay, France
| | - G Gibault-Genty
- Service de cardiologie, unité de soins intensif cardiologiques et cardiologie interventionnelle, centre hospitalier de Versailles, hôpital André-Mignot, 177, rue de Versailles, 78150 Le Chesnay, France
| | - G Cherif
- Service de cardiologie, unité de soins intensif cardiologiques et cardiologie interventionnelle, centre hospitalier de Versailles, hôpital André-Mignot, 177, rue de Versailles, 78150 Le Chesnay, France
| | - E Blicq
- Service de cardiologie, unité de soins intensif cardiologiques et cardiologie interventionnelle, centre hospitalier de Versailles, hôpital André-Mignot, 177, rue de Versailles, 78150 Le Chesnay, France
| | - S Azzaz
- Service de cardiologie, unité de soins intensif cardiologiques et cardiologie interventionnelle, centre hospitalier de Versailles, hôpital André-Mignot, 177, rue de Versailles, 78150 Le Chesnay, France
| | - P Schiano
- Service de cardiologie, unité de soins intensif cardiologiques et cardiologie interventionnelle, centre hospitalier de Versailles, hôpital André-Mignot, 177, rue de Versailles, 78150 Le Chesnay, France
| | - M Brami
- Service de cardiologie, unité de soins intensif cardiologiques et cardiologie interventionnelle, centre hospitalier de Versailles, hôpital André-Mignot, 177, rue de Versailles, 78150 Le Chesnay, France; Service de cardiologie, centre médico chirurgical de l'Europe, 78560 Le Port Marly, France
| | - L Sarfati
- Service de cardiologie, unité de soins intensif cardiologiques et cardiologie interventionnelle, centre hospitalier de Versailles, hôpital André-Mignot, 177, rue de Versailles, 78150 Le Chesnay, France; Service de cardiologie, centre médico chirurgical de l'Europe, 78560 Le Port Marly, France
| | - C Charbonnel
- Service de cardiologie, unité de soins intensif cardiologiques et cardiologie interventionnelle, centre hospitalier de Versailles, hôpital André-Mignot, 177, rue de Versailles, 78150 Le Chesnay, France
| | - R Convers-Domart
- Service de cardiologie, unité de soins intensif cardiologiques et cardiologie interventionnelle, centre hospitalier de Versailles, hôpital André-Mignot, 177, rue de Versailles, 78150 Le Chesnay, France
| | - B Livarek
- Service de cardiologie, unité de soins intensif cardiologiques et cardiologie interventionnelle, centre hospitalier de Versailles, hôpital André-Mignot, 177, rue de Versailles, 78150 Le Chesnay, France
| | - J-L Georges
- Service de cardiologie, unité de soins intensif cardiologiques et cardiologie interventionnelle, centre hospitalier de Versailles, hôpital André-Mignot, 177, rue de Versailles, 78150 Le Chesnay, France.
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Potdar A, Sharma S. The 'MAP strategy' (Maximum aspiration of atherothrombus and adjunctive glycoprotein IIb/IIIa inhibitor utilization combined with prolonged inflation of balloon/stent) for preventing no-reflow in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention: A retrospective analysis of seventy-one cases. Indian Heart J 2016; 67 Suppl 3:S43-6. [PMID: 26995430 PMCID: PMC4799003 DOI: 10.1016/j.ihj.2015.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 11/11/2015] [Indexed: 11/16/2022] Open
Abstract
'No-reflow' phenomenon is a common occurrence in percutaneous coronary intervention (PCI). A three-component 'MAP strategy' was designed to prevent no-reflow by addressing both intralesional and intraluminal thrombus in patients with ST-segment elevation myocardial infarction (STEMI). In this analysis, we observed Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 or 2 in all patients, with no incidence of no-reflow. Myocardial blush grade (MBG) 3 or 2 was observed in most (87.32%) patients. Left ventricular ejection fraction (LVEF) was improved, without any incidence of death up to 9-month follow-up. All patients safely tolerated the strategy-driven prolonged, 35-s inflation of the balloon/stent.
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Affiliation(s)
- Anil Potdar
- Director, Department of Cardiology, H.J. Doshi Ghatkopar Hindu Sabha Hospital, Mumbai, Maharashtra, India.
| | - Satyavan Sharma
- Head of Department of Cardiology, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
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Kaymaz C, Keleş N, Özdemir N, Tanboğa İH, Demircan HC, Can MM, Koca F, İzgi İA, Özkan A, Türkmen M, Kırma C, Esen AM. The effects of tirofiban infusion on clinical and angiographic outcomes of patients with STEMI undergoing primary PCI. Anatol J Cardiol 2015; 15:899-906. [PMID: 25868037 PMCID: PMC5336940 DOI: 10.5152/akd.2014.5656] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: The present study was designed to determine the effects of tirofiban (Tiro) infusion on angiographic measures, ST-segment resolution, and clinical outcomes in patients with STEMI undergoing PCI. Glycoprotein (GP) IIb/IIIa inhibitors are beneficial in ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI), while the most effective timing of administration is still under investigation. Methods: A total of 1242 patients (83.0% males, mean (standard deviation; SD) age: 54.7 (10.9) years) with STEMI who underwent primary PCI were included in this retrospective non-randomized study in four groups, composed of no tirofiban infusion [Tiro (-); n=248], tirofiban infusion before PCI (pre-Tiro; n=720), tirofiban infusion during PCI (peri-Tiro; n=50), and tirofiban infusion after PCI (post-Tiro; n=224). In all Tiro (+) patients, bolus administration of Tiro (10 pg/kg) was followed by infusion (0.15 pg/kg/min) for a mean (SD) duration of 22.4±6.8 hours. Results: The pre-PCI Tiro group was associated with the highest percentage of patients with TIMI 3 flow (99.4%; p<0.001), the lowest corrected TIMI frame count [21(18-23.4); p<0.001], the highest percentage of patients with >75% ST-segment resolution (78.1%; p<0.001), and the lowest rate of in-hospital sudden cardiac death and in-hospital all-cause mortality (3.2%, p<0.05, 3.3%, p=0.01). Major bleeding was reported in 18 (1.8%) patients who received tirofiban. Conclusion: Use of standard-dose bolus tirofiban in addition to aspirin, high-dose clopidogrel, and unfractionated heparin prior to primary PCI significantly improves myocardial reperfusion, ST-segment resolution, in-hospital mortality rate, and in-hospital sudden cardiac death in patients with STEMI with no increased risk of major bleeding.
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Affiliation(s)
- Cihangir Kaymaz
- Department of Cardiology, Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital; İstanbul-Turkey.
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Akpek M, Sahin O, Sarli B, Baktir AO, Saglam H, Urkmez S, Ergin A, Oguzhan A, Arinc H, Kaya MG. Acute Effects of Intracoronary Tirofiban on No-Reflow Phenomena in Patients With ST-Segment Elevated Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Angiology 2014; 66:560-7. [DOI: 10.1177/0003319714545780] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We evaluated the acute effect of intracoronary administration of tirofiban on no-reflow phenomenon in patients with ST-segment elevated myocardial infarction undergoing primary percutaneous coronary intervention. Consecutive patients (n = 162) were randomized into 2 groups based on whether intracoronary tirofiban was administered. After the administration of intracoronary tirofiban, thrombolysis in myocardial infarction (TIMI) flow grade significantly increased ( P < .001) and successful reperfusion was achieved in 26 (32%) patients. In the placebo group, however, after the administration of intracoronary placebo the TIMI flow grade did not change ( P = .070), and successful reperfusion was achieved only in 8 (10%) patients. In-hospital major adverse cardiac events (MACE) were significantly lower in the tirofiban group (36% vs 19%, P = .013). Intracoronary administration of tirofiban significantly improves TIMI flow grade and is associated with a lower in-hospital rate of MACE.
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Affiliation(s)
- Mahmut Akpek
- Department of Cardiology, Kayseri Education and Research Hospital, Kayseri, Turkey
| | - Omer Sahin
- Department of Cardiology, Kayseri Education and Research Hospital, Kayseri, Turkey
| | - Bahadir Sarli
- Department of Cardiology, Kayseri Education and Research Hospital, Kayseri, Turkey
| | - Ahmet Oguz Baktir
- Department of Cardiology, Kayseri Education and Research Hospital, Kayseri, Turkey
| | - Hayrettin Saglam
- Department of Cardiology, Kayseri Education and Research Hospital, Kayseri, Turkey
| | - Serkan Urkmez
- Department of Cardiology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Ali Ergin
- Department of Cardiology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Abdurrahman Oguzhan
- Department of Cardiology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Huseyin Arinc
- Department of Cardiology, Kayseri Education and Research Hospital, Kayseri, Turkey
| | - Mehmet G. Kaya
- Department of Cardiology, Erciyes University School of Medicine, Kayseri, Turkey
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Topcu S, Karal H, Kaya A, Bakirci EM, Tanboga IH, Kurt M, Aksakal E, Acikel M, Sevimli S. The Safety and Efficacy of 12 Versus 24 Hours of Tirofiban Infusion in Patients Undergoing Primary Percutaneous Coronary Intervention. Clin Appl Thromb Hemost 2014; 21:783-9. [DOI: 10.1177/1076029614529841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Aim: We aimed to investigate the 6-month efficacy and safety of postprocedural 12-hour tirofiban administration versus 24-hour tirofiban administration in patients with ST-segment elevated myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). Methods: This retrospective study enrolled 349 patients with STEMI who underwent primary PCI. Following the administration of bolus tirofiban after primary PCI, those receiving a 12-hour tirofiban infusion as the maintenance dose were classified as group 1 (n = 123) while those receiving a 24-hour infusion were classified as group 2 (n = 226). In-hospital and 6-month major adverse cardiac events were recorded. Results: There were no statistically significant differences between the 2 groups regarding in-hospital efficacy (in-hospital death: 4.4% vs 5.7%, P = .600 and stent thrombosis 1.8% vs 1.6%, P = .921) and in-hospital safety (2.6% vs 1.6% for major bleeding and 5.3% vs 4.1% for minor bleeding, P = .562). During the 6-month follow-up period, the incidence of the recurrent revascularization (16.1% vs 15.5%, odds ratio [OR] = 1.05 [0.47-3.67]), the repeated nonfatal acute coronary syndrome and/or stent thrombosis (27% vs 24.4%, P = .598, OR = 1.02 [0.42-2.48]), and the cardiovascular deaths (6.6% vs 6.5%, P = .943, OR = 1.03 [0.43-2.43]) were comparable between group 1 and group 2. Conclusion: Our study revealed that 12-hour tirofiban administration versus 24-hour tirofiban administration in STEMI who underwent primary PCI was similar with respect to in-hospital efficacy and safety and major adverse cardiac events during 6-month follow-up.
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Affiliation(s)
- Selim Topcu
- Department of Cardiology, Medical School, Ataturk University, Erzurum, Turkey
| | - Huseyin Karal
- Department of Cardiology, Medical School, Ataturk University, Erzurum, Turkey
| | - Ahmet Kaya
- Department of Cardiology, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Eftal Murat Bakirci
- Department of Cardiology, Medical School, Ataturk University, Erzurum, Turkey
| | | | - Mustafa Kurt
- Department of Cardiology, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Enbiya Aksakal
- Department of Cardiology, Medical School, Ataturk University, Erzurum, Turkey
| | - Mahmut Acikel
- Department of Cardiology, Medical School, Ataturk University, Erzurum, Turkey
| | - Serdar Sevimli
- Department of Cardiology, Medical School, Ataturk University, Erzurum, Turkey
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Qin T, Xie L, Chen MH. Meta-analysis of randomized controlled trials on the efficacy and safety of intracoronary administration of tirofiban for no-reflow phenomenon. BMC Cardiovasc Disord 2013; 13:68. [PMID: 24016038 PMCID: PMC3847195 DOI: 10.1186/1471-2261-13-68] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 08/28/2013] [Indexed: 12/22/2022] Open
Abstract
Background Currently, there is still a lack of an optimal treatment for no-reflow phenomenon (NR). The aim of this simple meta-analysis was to evaluate the efficacy and safety of intracoronary (IC) administration of tirofiban compared with other conventional drugs during percutaneous coronary intervention (PCI) for NR. Methods Systematic literature search was done from PubMed, EMBASE, Google Scholar, EBSCO, Springer and CNKI databases without language or time limitation. Randomized controlled trials were enrolled for analyzing if they investigated the treatment of IC administration of tirofiban versus other conventional drugs for NR. Results Ten studies with 702 patients were included. Significantly, the treatment of tirofiban was more effective in improving the thrombolysis in myocardial infarction (TIMI) flow (OR 0.24, 95% CI 0.15-0.37, P < 0.00001) and reducing major adverse cardiovascular events (MACE) (OR 0.09, 95% CI 0.05-0.18, P < 0.00001). There was a trend to increase the risk of bleeding, but the data of the result did not reach the statistical significance (OR 1.44, 95% CI 0.69-3.00, P = 0.32). Conclusions Tirofiban is more effective than conventional drugs for NR during PCI, but the potential risk of bleeding complication induced by tirofiban shouldn’t be ignored during clinical practices.
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Affiliation(s)
- Tao Qin
- Institute of Cardiovascular Diseases, the First Affiliated Hospital of Guangxi, Medical University, Nanning, Guangxi, 530027, P, R, China.
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Fu G, Jia L, Zhao X, Wang Y, Chen X, Yang Y, Lu N, Zhao W, Hui R, Zheng Y. A comparison of intracoronary with intravenous glycoprotein IIb/IIIa inhibitors during percutaneous coronary intervention in patients with acute coronary syndrome: a meta-analysis of randomized controlled trials. J Interv Cardiol 2012; 25:223-34. [PMID: 22413751 DOI: 10.1111/j.1540-8183.2011.00711.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND It is still debatable whether intracoronary (IC) administration of glycoprotein IIb/IIIa inhibitors (GPIs) is superior to intravenous (IV) administration for patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). METHODS We performed a meta-analysis of randomized controlled clinical trials. A literature search was conducted for relevant trials. Primary end-points were short-term (1-3 months) and mid-/long-term (6/12 months) major adverse cardiovascular events (MACEs) (mortality, reinfarction, target vessel revascularization [TVR]). Secondary end-points were thrombolysis in myocardial infarction (TIMI) grade flow, TIMI myocardial perfusion grade (TMPG) flow, left ventricular ejection fraction (LVEF) within 2 weeks, and bleeding complication. RESULTS Twelve studies were included in the meta-analysis. IC administration of GPIs did not decrease short-term mortality (OR: 0.71, 95% CI: 0.41-1.23, P = 0.22) and reinfarction rate (OR: 0.76, 95% CI: 0.45-1.29, P = 0.31) compared with IV administration. There was a trend toward reduction of short-term TVR rate in IC group compared with IV group but not reaching statistical significance (OR: 0.57, 95% CI: 0.31-1.04, P = 0.07). IC administration of GPIs significantly increased TIMI grade 3 flow (OR: 1.48, 95% CI: 1.06-2.06, P = 0.02) and TMPG grade 2-3 flow (OR: 2.63, 95% CI: 1.53-4.51, P = 0.0004) compared with IV administration. No significant difference was observed in long-term MACEs rate, LVEF, and bleeding complication between the 2 groups. CONCLUSION IC administration of GPIs in patients with ACS undergoing PCI can significantly increase target coronary flow and myocardial reperfusion without increasing the risk of bleeding complication, but cannot improve clinical outcome compared with IV administration.
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Affiliation(s)
- Gang Fu
- Department of Cardiovascular Diseases, Bethune First Hospital of Jilin University, Changchun, China
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