title: Beneficial effects of intracoronary tirofiban bolus administration following upstream intravenous treatment in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: the ICT-AMI study.
abstract: BACKGROUND
  We investigated whether an additional intracoronary tirofiban bolus administration following upstream intravenous treatment could further improve myocardial reperfusion and clinical outcome in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).
  
  
  METHODS
  A total of 453 eligible STEMI patients were randomly allocated to intracoronary bolus administration of tirofiban (10 μg/kg; n=229) or saline (10 mL; n=224) during primary PCI, followed by intravenous tirofiban infusion (0.15 μg/kg/min) for 24-36 h. Serum levels of P-selectin, vWF, CD40L and serum amyloid A (SAA) in the coronary sinus were measured before and after intracoronary bolus administration. The primary endpoint was ST-segment resolution (STR) at 90 min after the procedure. Second endpoints included corrected TIMI frame count (cTFC), left ventricular volumes and ejection fraction (EF), and major adverse cardiac events (MACE) at 30-day and 6-month follow-up.
  
  
  RESULTS
  Intracoronary tirofiban administration resulted in a higher rate of completed STR (59.0% vs. 44.6%, P=0.002), lower cTFC (21.6±5.4 vs. 23.7±7.8, P=0.048), and significantly reduced coronary sinus levels of P-selectin, vWF, CD40L and SAA. Patients treated with intracoronary tirofiban had a trend toward less MACE at 30 days (3.1% vs. 6.7%, P=0.072). At 6 months, left ventricular end-systolic volume was smaller, EF was higher and MACE-free survival was improved (96.1% vs. 90.6%, P=0.020) in the intracoronary tirofiban group.
  
  
  CONCLUSIONS
  An additional intracoronary tirofiban bolus administration following upstream intravenous treatment reduces coronary circulatory platelet activation and inflammatory process, and significantly improves myocardial reperfusion and left ventricular function as well as 6-month MACE-free survival for STEMI patients undergoing primary PCI.
authors.affiliation: Department of Cardiology, Rui Jin Hospital, Jiao Tong University School of Medicine, Shanghai 200025, People's Republic of China.
authors.forename: Tian Qi
authors.initials: TQ
authors.lastname: Zhu
authors.forename: Qi
authors.initials: Q
authors.lastname: Zhang
authors.forename: Jian Ping
authors.initials: JP
authors.lastname: Qiu
authors.forename: Hui Geng
authors.initials: HG
authors.lastname: Jin
authors.forename: Lin
authors.initials: L
authors.lastname: Lu
authors.forename: Jie
authors.initials: J
authors.lastname: Shen
authors.forename: Liang Ping
authors.initials: LP
authors.lastname: Zhao
authors.forename: Rui Yan
authors.initials: RY
authors.lastname: Zhang
authors.forename: Jian
authors.initials: J
authors.lastname: Hu
authors.forename: Zhen Kun
authors.initials: ZK
authors.lastname: Yang
authors.forename: Wei Feng
authors.initials: WF
authors.lastname: Shen
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000378:metabolism / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors* / Q000378:metabolism; D000077466:Tirofiban; D016896:Treatment Outcome; D014443:Tyrosine / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D014443:Tyrosine; D000077466:Tirofiban