Skip to main content
SpringerLink
Log in

Effects of Tirofiban Maintenance Duration on Myocardial Perfusion Defect Severity in Anterior Myocardial Infarction

  • Original Research
  • Published:
Advances in Therapy Aims and scope Submit manuscript

Abstract

Introduction

Percutaneous coronary intervention (PCI) does not often produce optimal results, despite restoration of coronary blood flow at myocardial recovery, because of impaired microvascular perfusion. This study aimed to investigate and evaluate with 99mTc-sestamibi scan whether the results of PCI can be changed by maintenance infusion of tirofiban for 24 or 48 h in patients presenting with anterior ST-elevation myocardial infarction (STEMI).

Methods

The study included 84 patients with anterior STEMI who were candidates for primary PCI and whose occlusion was in the proximal or mid-left anterior descending artery. Patients were given 25 μg/kg/3 min tirofiban and randomized to receive maintenance infusion at 0.15 μg/kg/min for 24 or 48 h. A resting 99mTc sestamibi scan was performed on the 5th day post-procedure before discharge. The primary efficacy endpoint was a patient’s score on a 5-point scoring system for perfusion defect severity. Major adverse cardiac events (MACE) were defined as death from any cause, re-infarction, and clinically driven target-vessel revascularization within the first 6 months.

Results

Baseline characteristics of the patients were similar in the two infusion groups (n = 42 per group). There was no significant difference in the symptom onset-to-presentation time or door-to-balloon time between the two groups. With the exception of basal anteroseptal and basal anterior segments, significant reductions were obtained on the 5-point scoring system for perfusion defect severity in segments and in the summed rest scores. No significant differences were observed between the two groups in the incidence of MACE at 6 months. The safety profile did not differ between 24 and 48 h infusions of tirofiban.

Conclusion

The use of tirofiban, when administered at a high bolus dose and maintained for 48 h, was safe and significantly reduced perfusion defect severity in patients with anterior STEMI presenting early after symptom onset and undergoing primary PCI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Falk E. Coronary thrombosis: pathogenesis and clinical manifestations. Am J Cardiol. 1991;68:28B–35B.

    Article  PubMed  CAS  Google Scholar 

  2. Andersen HR, Nielsen TT, Rasmussen K, et al. A comparison of coronary angioplasty with fibrinolytic therapy in acute myocardial infarction. N Engl J Med. 2003;349:733–42.

    Article  PubMed  Google Scholar 

  3. Stenestrand U, Lindbäck J, Wallentin L, RIKS-HIA Registry. Long-term outcome of primary percutaneous coronary intervention vs prehospital and in-hospital thrombolysis for patients with ST-elevation myocardial infarction. JAMA. 2006;296:1749–56.

    Article  PubMed  CAS  Google Scholar 

  4. O’Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. American College of Emergency Physicians; Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol. 2013;61:e78–140.

    Article  PubMed  Google Scholar 

  5. Brener SJ, Cristea E, Mehran R, Dressler O, Lansky AJ, Stone GW. Relationship between angiographic dynamic and densitometric assessment of myocardial reperfusion and survival in patients with acute myocardial infarction treated with primary percutaneous coronary intervention: the harmonizing outcomes with revascularization and stents in AMI (HORIZONS-AMI) trial. Am Heart J. 2011;162:1044–51.

    Article  PubMed  Google Scholar 

  6. Stone GW, Maehara A, Witzenbichler B, et al. Intracoronary abciximab and aspiration thrombectomy in patients with large anterior myocardial infarction: the INFUSE-AMI randomized trial. JAMA. 2012;307:1817–26.

    Article  PubMed  CAS  Google Scholar 

  7. Gibbons RJ, Christian TF, Hopfenspirger M, Hodge DO, Bailey KR. Myocardium at risk and infarct size after thrombolytic therapy for acute myocardial infarction: implications for the design of randomized trials of acute intervention. J Am Coll Cardiol. 1994;24:616–23.

    Article  PubMed  CAS  Google Scholar 

  8. Gibbons RJ, Miller TD, Christian TF. Infarct size measured by single photon emission computed tomographic imaging with (99m)Tc-sestamibi: a measure of the efficacy of therapy in acute myocardial infarction. Circulation. 2000;101:101–8.

    Article  PubMed  CAS  Google Scholar 

  9. Lang SH, Manning N, Armstrong N, et al. Treatment with tirofiban for acute coronary syndrome (ACS): a systematic review and network analysis. Curr Med Res Opin. 2012;28:351–70.

    Article  PubMed  CAS  Google Scholar 

  10. Valgimigli M, Campo G, Percoco G, et al. Comparison of angioplasty with infusion of tirofiban or abciximab and with implantation of sirolimus-eluting or uncoated stents for acute myocardial infarction: the MULTISTRATEGY randomized trial. JAMA. 2008;299:1788–99.

    Article  PubMed  CAS  Google Scholar 

  11. Van’t Hof AW, Ten Berg J, Heestermans T, et al. Prehospital initiation of tirofiban in patients with ST-elevation myocardial infarction undergoing primary angioplasty (On-TIME 2): a multicentre, double-blind, randomised controlled trial. Lancet. 2008;372:537–46.

    Article  PubMed  Google Scholar 

  12. Balghith MA. High bolus tirofiban vs abciximab in acute STEMI patients undergoing primary PCI—the Tamip Study. Heart Views. 2012;13:85–90.

    Article  PubMed  Google Scholar 

  13. Pereztol-Valdés O, Candell-Riera J, Santana-Boado C, et al. Correspondence between left ventricular 17 myocardial segments and coronary arteries. Eur Heart J. 2005;26:2637–43.

    Article  PubMed  Google Scholar 

  14. Carlsson M, Hedeer F, Engblom H, Arheden H. Head-to-head comparison of a 2-day myocardial perfusion gated SPECT protocol and cardiac magnetic resonance late gadolinium enhancement for the detection of myocardial infarction. J Nucl Cardiol. 2013 Jul 10 (Epub ahead of print).

  15. Berman DS, Hachamovitch R, Kiat H, et al. Incremental value of prognostic testing in patients with known or suspected ischemic heart disease: a basis for optimal utilization of exercise technetium-99m sestamibi myocardial perfusion single photon emission computed tomography. J Am Coll Cardiol. 1995;26:639–47.

    Article  PubMed  CAS  Google Scholar 

  16. Zijlstra F, de Boer MJ, Hoorntje JC, Reiffers S, Reiber JH, Suryapranata H. A comparison of immediate coronary angioplasty with intravenous streptokinase in acute myocardial infarction. N Engl J Med. 1993;328:680–4.

    Article  PubMed  CAS  Google Scholar 

  17. Lee KL, Woodlief LH, Topol EJ, et al. Predictors of 30-day mortality in the era of reperfusion for acute myocardial infarction: results from international trial of 41,021 patients. GUSTO-I Investigators. Circulation. 1995;91:1659–68.

    Article  PubMed  CAS  Google Scholar 

  18. Martínez-Ríos MA, Rosas M, González H, et al. Comparison of reperfusion regimens with or without tirofiban in ST-elevation acute myocardial infarction. Am J Cardiol. 2004;93:280–7.

    Article  PubMed  Google Scholar 

  19. Gersh BJ, Stone GW, White HD, Holmes DR Jr. Pharmacological facilitation of primary percutaneous coronary intervention for acute myocardial infarction: is the slope of the curve the shape of the future? JAMA. 2005;293:979–86.

    Article  PubMed  CAS  Google Scholar 

  20. The RESTORE Investigators. Effects of platelet glycoprotein IIb/IIIa blockade with tirofiban on adverse cardiac events in patients with unstable angina or acute myocardial infarction undergoing coronary angioplasty. Circulation. 1997;96:1445–53.

    Article  Google Scholar 

  21. Liu X, Tao GZ. Effects of tirofiban on the reperfusion-related no-reflow in rats with acute myocardial infarction. J Geriatr Cardiol. 2013;10:52–8.

    PubMed  CAS  Google Scholar 

  22. Heestermans AA, Hermanides RS, Gosselink AT, et al. A comparison between upfront high-dose tirofiban versus provisional use in the real-world of non-selected STEMI patients undergoing primary PCI: insights from the Zwolle acute myocardial infarction registry. Neth Heart J. 2010;18:592–7.

    Article  Google Scholar 

  23. Schneider DJ, Herrmann HC, Lakkis N, et al. Increased concentrations of tirofiban in blood and their correlation with inhibition of platelet aggregation after greater bolus doses of tirofiban. Am J Cardiol. 2003;91:334–6.

    Article  PubMed  CAS  Google Scholar 

  24. Batchelor WB, Tolleson TR, Huang Y, et al. Randomized COMparison of platelet inhibition with abciximab, tiRofiban and eptifibatide during percutaneous coronary intervention in acute coronary syndromes: the COMPARE trial. Comparison of Measurements of Platelet aggregation with Aggrastat, Reopro, and Eptifibatide. Circulation. 2002;106:1470–6.

    Article  PubMed  CAS  Google Scholar 

  25. Ibrahim T, Bulow HP, Hackl T, et al. Diagnostic value of contrast-enhanced magnetic resonance imaging and single-photon emission computed tomography for detection of myocardial necrosis early after acute myocardial infarction. J Am Coll Cardiol. 2007;49:208–16.

    Article  PubMed  Google Scholar 

  26. Wagner A, Mahrholdt H, Holly TA, et al. Contrast-enhanced MRI and routine single photon emission computed tomography (SPECT) perfusion imaging for detection of subendocardial myocardial infarcts: an imaging study. Lancet. 2003;361:374–9.

    Article  PubMed  Google Scholar 

  27. Onishi T, Kobayashi I, Onishi Y, et al. Evaluating microvascular obstruction after acute myocardial infarction using cardiac magnetic resonance imaging and 201-thallium and 99m-technetium pyrophosphate scintigraphy. Circ J. 2010;74:2633–40.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Atatürk University Rectorate and Chiesi Pharmaceutical Company employees, Tufan Yildirim and Oguz Ozturk, for their helpful discussions. No funding or sponsorship was received for this study or publication of this article.

Conflict of interest

M. Hakan Tas, Ziya Simsek, Arif Ayan, Ugur Aksu, Selami Demirelli, Yavuzer Koza, Zakir Lazoglu, Bedri Seven, and Huseyin Senocak declare that they have no conflict of interest. Dr. Tas is the guarantor for this article, and takes responsibility for the integrity of the work as a whole.

Compliance with ethics guidelines

The study was approved by the local ethical committee of the Atatürk University (B.30.2ATA.0.01.00/3). All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

Author information

Authors and Affiliations

  1. Department of Cardiology, Faculty of Medicine, Atatürk University, Erzurum, Turkey

    M. Hakan Tas, Ziya Simsek, Ugur Aksu, Yavuzer Koza, Zakir Lazoglu & Huseyin Senocak

  2. Department of Nuclear Medicine, Faculty of Medicine, Atatürk University, Erzurum, Turkey

    Arif Ayan & Bedri Seven

  3. Department of Cardiology, Regional Training and Research Hospital, Erzurum, Turkey

    Selami Demirelli

Authors
  1. M. Hakan Tas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ziya Simsek
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Arif Ayan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ugur Aksu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Selami Demirelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yavuzer Koza
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Zakir Lazoglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Bedri Seven
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Huseyin Senocak
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Hakan Tas.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tas, M.H., Simsek, Z., Ayan, A. et al. Effects of Tirofiban Maintenance Duration on Myocardial Perfusion Defect Severity in Anterior Myocardial Infarction. Adv Ther 30, 834–844 (2013). https://doi.org/10.1007/s12325-013-0055-y

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12325-013-0055-y

Keywords

Search

Navigation