title: Efficacy and Safety of Intracoronary versus Intravenous Administration of Tirofiban during Percutaneous Coronary Intervention for Acute Coronary Syndrome: A Meta-Analysis of Randomized Controlled Trials.
abstract: BACKGROUND
  Percutaneous coronary intervention (PCI) is known as the most effective treatment for acute coronary syndrome (ACS). However, without proper therapy and patient management, stent thrombosis after PCI may lead to another myocardial infarction. In addition to aspirin and clopidogrel, tirofiban is often used as an antiplatelet therapy in patients with ACS. To date, there has been no comprehensive evaluation of the efficacy and safety of intracoronary (IC) tirofiban administration for ACS patients undergoing PCI compared with intravenous (IV) administration. Therefore, this meta-analysis was conducted to investigate the clinical efficiency and safety of IC versus intravenous (IV) tirofiban in ACS patients undergoing PCI.
  
  
  METHODS
  We searched PubMed and Medline for randomized controlled trials (RCTs) comparing IC versus IV administration of tirofiban in ACS patients undergoing PCI. We evaluated the effects of tirofiban on thrombolysis in myocardial infarction (TIMI) grade 3 flow after PCI, TIMI myocardial perfusion grade 3 (TMP grade 3), left ventricular ejection fraction (LVEF), major adverse cardiovascular events (MACE), target vessel revascularization (TVR), death, reinfarction and adverse drug effects (specifically bleeding events).
  
  
  RESULTS
  Seven trials involving 1,027 patients were included in this meta-analysis. IC administration of tirofiban significantly increased TIMI grade 3 flow (OR 2.11; 95% CI 1.02 to 4.37; P = 0.04) and TMP grade 3 (OR 2.67; 95% CI 1.09 to 6.49; P = 0.03, I2 = 64%) while reducing MACE (OR 0.46, 95% CI: 0.28 to 0.75; P = 0.002) compared with IV administration of tirofiban. No significant differences were observed in the occurrence of TVR, death, reinfarction and the incidence of bleeding events between the two groups.
  
  
  CONCLUSIONS
  This meta-analysis supports the use of IC over IV administration of tirofiban in patients with ACS to improve TIMI flow, TMP flow and MACE. However, there was no statistically significant difference in the risk of bleeding complications between the two groups.
authors.affiliation: Department of Cardiology, The first hospital of QinHuangDao, QinHuangDao, HeBei, China.
authors.forename: Xiuying
authors.initials: X
authors.lastname: Tang
authors.affiliation: Department of Emergency Medicine, The first hospital of QinHuangDao, QinHuangDao, HeBei, China.
authors.forename: Runjun
authors.initials: R
authors.lastname: Li
authors.affiliation: Department of Cardiology, General Hospital of Shenyang Military Area Command, Shenyang, LiaoNing, China.
authors.forename: Quanmin
authors.initials: Q
authors.lastname: Jing
authors.affiliation: Department of Cardiology, Zhujiang hospital, Southern Medical University, GuangZhou, GuangDong, China.
authors.forename: Yingfeng
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Cardiology, Zhujiang hospital, Southern Medical University, GuangZhou, GuangDong, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Liu
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D061605:Administration, Intravenous; D006801:Humans; D036502:Infusions, Intralesional; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D016032:Randomized Controlled Trials as Topic; D000077466:Tirofiban; D016896:Treatment Outcome; D014443:Tyrosine / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D010975:Platelet Aggregation Inhibitors; D014443:Tyrosine; D000077466:Tirofiban