Additive benefit of glycoprotein IIb/IIIa inhibition and adjunctive thrombus aspiration during primary coronary intervention: results of the Initial Thrombosuction and Tirofiban Infusion (ITTI) trial.
BACKGROUND
Thrombus aspiration has been shown to provide significant benefits during primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). The aim of the current study was to evaluate the additional benefit of tirofiban to thrombus aspiration during primary PCI in myocardial reperfusion.


METHODS
100 STEMI patients were randomized according to a 2 × 2 factorial design into 1 of the 4 groups: standard PCI, PCI with initial thrombus aspiration (IT), PCI with tirofiban infusion (TI), and PCI with both treatments (IT+TI).


RESULTS
The myocardial blush grade (MBG) 3 was achieved in 30.4%, 45.8%, 56% and 78.6% in the 4 groups respectively. More frequent MBG 3 (p=0.015) and complete (>70%) ST-segment resolution (STR, 67.9% vs. 41.7%, p=0.058) were observed in IT ± TI group compared with IT group. If actuarial analysis was done after reassigning the 2 TI patients who crossed over to IT+TI, the difference between IT+TI and IT groups became more significant (MBG 3 rates: 76.7% vs. 45.8%, p=0.009; complete STR rates: 70% vs. 41.7%, p=0.036). Infusion of tirofiban resulted in improved MBG and STR (p=0.003 and 0.037, respectively). Thrombus aspiration resulted in improved MBG only (p=0.048) but not in STR. 6-month MACE (death, reinfarction, target lesion revascularization and stroke) was similar among groups (p=0.725).


CONCLUSIONS
Tirofiban may augment thrombus aspiration therapy on myocardial reperfusion in primary PCI. The benefit of thrombus aspiration treatment without tirofiban might be less significant, especially on resolution of ST-segment elevation.
Department of Internal Medicine, Yuan's General Hospital and Graduate Institute of Medicine, Kaohsiung Medical University, Taiwan.
Chung-Pin
CP
Liu
Mao-Shin
MS
Lin
Yu-Wei
YW
Chiu
Jen-Kuang
JK
Lee
Chih-Neng
CN
Hsu
Chi-Shen
CS
Hung
Hsien-Li
HL
Kao
D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy / Q000379:methods; D003328:Coronary Thrombosis / Q000188:drug therapy* / Q000378:metabolism / Q000601:surgery*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors* / Q000378:metabolism; D011446:Prospective Studies; D013396:Suction; D000077466:Tirofiban; D016896:Treatment Outcome; D014443:Tyrosine / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use
D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D014443:Tyrosine; D000077466:Tirofiban