Effect of Early Treatment With Tirofiban on Initial TIMI Grade 3 Flow of Patients With ST Elevation Myocardial Infarction.
BACKGROUND
Before primary percutaneous coronary intervention (PCI) in patients with ST elevation myocardial infarction (STEMI), it is not clear whether a routine early administration of glycoprotein IIb/IIIa inhibitors in the emergency ward is beneficial or their administration in selected cases in the catheterization laboratory.


OBJECTIVE
The present randomized clinical trial sought to investigate whether an earlier administration of Tirofiban could exert any impact on TIMI grade 3 flows and ST resolution in the electrocardiography of patients with STEMI before primary PCI.


METHODS
Patients with STEMI within twelve hours of symptom commencement were included if primary PCI was planned to be performed within ninety minutes of admission and excluded if they had contraindications for Tirofiban. Seventy patients were randomized to receive 25 μg/kg of bolus Tirofiban early in the emergency ward (the early Tirofiban group) in three minutes and 70 did not receive Tirofiban (the control group). The primary endpoint of the study was a Thrombolysis in Myocardial Infarction (TIMI) grade 3 flows on the initial angiogram. The study is registered as IRCT201105126463N1 in: www.irct.ir.


RESULTS
The study population had a mean age of 57.17 ± 10.09 years and included 79.3 % males. TIMI grade 3 flow was seen in 15 (21.4 %) patients of the Tirofiban group and 7 (10 %) of the control group (P = 0.06, odds ratio = 0.407, and 95 % confidence interval = 0.155-1.072). Complete ST resolution was seen in 30 (42.9 %) patients of the Tirofiban group and 34 (48.6 %) of the control group (P = 0.5).


CONCLUSIONS
Although TIMI grade 3 flows trended to be higher in the patients who received early Tirofiban in the emergency ward, the difference did not constitute statistical significance and possible benefits, therefore, require further clarification.
Department of Cardiology, Tehran University of Medical Sciences, Tehran Heart Center Hospital, Tehran, IR Iran.
Mojtaba
M
Salarifar
Department of Cardiology, Alborz University of Medical Sciences, Shahid Rajai Hospital, Karaj, IR Iran.
Mehdi
M
Mousavi
Department of Cardiology, Tehran University of Medical Sciences, Tehran Heart Center Hospital, Tehran, IR Iran.
Narges
N
Yousefpour
Department of Cardiology, Tehran University of Medical Sciences, Tehran Heart Center Hospital, Tehran, IR Iran.
Ebrahim
E
Nematipour
Department of Cardiology, Tehran University of Medical Sciences, Tehran Heart Center Hospital, Tehran, IR Iran.
Seyed Ebrahim
SE
Kassaian
Department of Cardiology, Tehran University of Medical Sciences, Tehran Heart Center Hospital, Tehran, IR Iran.
Hamidreza
H
Poorhosseini
Department of Cardiology, Tehran University of Medical Sciences, Tehran Heart Center Hospital, Tehran, IR Iran.
Alimohammad
A
Hajizeinali
Department of Cardiology, Tehran University of Medical Sciences, Tehran Heart Center Hospital, Tehran, IR Iran.
Mohammad
M
Alidoosti
Department of Cardiology, Tehran University of Medical Sciences, Tehran Heart Center Hospital, Tehran, IR Iran.
Hassan
H
Aghajani
Department of Cardiology, Tehran University of Medical Sciences, Tehran Heart Center Hospital, Tehran, IR Iran.
Younes
Y
Nozari
Department of Cardiology, Tehran University of Medical Sciences, Tehran Heart Center Hospital, Tehran, IR Iran.
Alireza
A
Amirzadegan
Department of Cardiology, Tehran University of Medical Sciences, Tehran Heart Center Hospital, Tehran, IR Iran.
Ali
A
Bozorgi
Department of Cardiology, Tehran University of Medical Sciences, Tehran Heart Center Hospital, Tehran, IR Iran.
Yaser
Y
Genab
Angiography; Myocardial Infarction; Percutaneous Coronary Intervention; Tirofiban