title: Intracoronary bolus-only compared with intravenous bolus plus infusion of tirofiban application in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention.
abstract: OBJECTIVE
  The aim of this pilot study was to compare intracoronary bolus-only with standard intravenous bolus plus maintenance infusion of tirofiban with respect to improvement in myocardial reperfusion after primary percutaneous coronary intervention (p-PCI).
  
  
  BACKGROUND
  Changes in clinical practice may obviate the need for a maintenance infusion of small molecule glycoprotein IIb/IIIa inhibitors in current practice.
  
  
  METHODS
  Forty-nine patients undergoing p-PCI were randomized to either intracoronary bolus-only (n = 25) or intravenous bolus plus infusion (n = 24) of tirofiban. The primary end point was coronary hemodynamic indices of microvascular perfusion measured 4-5 days after p-PCI. The secondary end points were ST segment resolution at 90 min, the corrected TIMI frame count and myocardial blush grade. At 6 months, echocardiography and technetium-99m single-photon-emission computed tomography were performed.
  
  
  RESULTS
  Microvascular perfusion did not differ significantly between the two treatment groups: index of microvascular resistance (27 ± 13 vs. 35 ± 15 U, P = 0.08) and coronary flow reserve (2.2 ± 0.7 vs. 1.9 ± 0.6, P = 0.25). The corrected TIMI frame counts assessed in the first (P = 0.13) and the second (P = 0.09) catheterization or the myocardial blush grades evaluated immediately (P = 0.23) and 4-5 days after MI (P = 1.00) were not significantly different between the two groups. At 6 months, there was no difference between the two groups in infarct size, left ventricular volumes, or ejection fraction.
  
  
  CONCLUSIONS
  The standard intravenous bolus plus maintenance infusion of tirofiban in p-PCI is not superior to intracoronary bolus-only administration with respect to microvascular perfusion. Further, adequately powered randomized trials are warranted to evaluate the clinical outcomes associated with this strategy.
authors.affiliation: Department of Cardiology, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey.
authors.forename: Cevat
authors.initials: C
authors.lastname: Kırma
authors.forename: Ayhan
authors.initials: A
authors.lastname: Erkol
authors.forename: Selçuk
authors.initials: S
authors.lastname: Pala
authors.forename: Vecih
authors.initials: V
authors.lastname: Oduncu
authors.forename: Cihan
authors.initials: C
authors.lastname: Dündar
authors.forename: Akın
authors.initials: A
authors.lastname: İzgi
authors.forename: Kürşat
authors.initials: K
authors.lastname: Tigen
authors.forename: C Michael
authors.initials: CM
authors.lastname: Gibson
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000187:drug effects; D004452:Echocardiography; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous; D007269:Injections, Intra-Arterial; D007275:Injections, Intravenous; D008297:Male; D008833:Microcirculation / Q000187:drug effects; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D010865:Pilot Projects; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011237:Predictive Value of Tests; D013997:Time Factors; D000077466:Tirofiban; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D014421:Turkey; D014443:Tyrosine / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D010975:Platelet Aggregation Inhibitors; D014443:Tyrosine; D000077466:Tirofiban