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Myocardial reperfusion with tirofiban injection via aspiration catheter

Efficacy and safety in STEMI patients with large thrombus burden

Myokardreperfusion mit Tirofibaninjektion via Aspirationskatheter

Wirksamkeit und Sicherheit bei STEMI-Patienten mit hoher Thrombuslast

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Abstract

Background

There is no consensus on the use of thrombus aspiration (TA) in primary percutaneous coronary intervention (PPCI), and few studies have focused on the performance of tirofiban via TA catheter after PPCI. Our study investigated the clinical outcome of tirofiban injection through TA in acute ST-segment elevation myocardial infarction (STEMI) patients with large thrombus burden undergoing PPCI treatment.

Patients and methods

The study comprised 122 STEMI patients who underwent TA during PPCI. Participants were randomly divided into two groups. Group A received intravenous tirofiban injection and tirofiban injection via a TA catheter to the infarcted coronary artery after aspiration (n = 61). Group B received intravenous tirofiban injection only (n = 61). Baseline clinical information and follow-up data were collected for both groups. Coronary angiography, electrocardiography, and echocardiography findings as well as major adverse cardiovascular events (MACE) were recorded.

Results

There were significant differences in postprocedural Thrombolysis in Myocardial Infarction (TIMI) grade 2 and 3 flow between the two groups (p = 0.021, p = 0.006, respectively). The incidence of slow-flow in group A was significantly lower than that of group B (p = 0.011). An increased incidence of no ST-segment resolution was observed in group B (p = 0.011). There were fewer major adverse cardiovascular events in group A than in group B, but the difference was not statistically significant.

Conclusion

Selective tirofiban injection via TA catheter during PPCI may improve myocardial reperfusion in STEMI patients with large thrombus burden.

Zusammenfassung

Hintergrund

In Bezug auf die Thrombusaspiration (TA) bei der primären perkutanen Koronarintervention (PPCI) besteht kein Konsens, und den Fokus auf die Leistungsfähigkeit von Tirofiban via TA-Katheter nach PPCI legten bisher nur wenige Studien. In der vorliegenden Studie wurde das klinische Ergebnis nach Tirofibaninjektion via TA-Katheter untersucht, und zwar bei Patienten mit akutem ST-Strecken-Hebungs-Infarkt („ST-segment elevation myocardial infarction“, STEMI) und hoher Thrombuslast, bei denen eine PPCI-Behandlung erfolgte.

Patienten und Methoden

Die Studie umfasste 122 STEMI-Patienten, bei denen eine TA im Rahmen der PPCI erfolgte. Die Teilnehmer wurden randomisiert in 2 Gruppen unterteilt. Gruppe A erhielt eine i.v.-Tirofibaninjektion und eine Tirofibaninjektion via TA-Katheter in die infarzierte Koronararterie nach TA (n = 61). Gruppe B erhielt nur eine i.v.-Tirofibaninjektion (n = 61). Für beide Gruppen wurden klinische Daten zu Beginn und im Verlauf erhoben. Die Befunde der Koronarangiographie, Elektrokardiographie und Echokardiographie sowie schwere kardiovaskuläre Nebenwirkungen („major adverse cardiovascular events“, MACE) wurden dokumentiert.

Ergebnisse

Zwischen den beiden Gruppen bestanden signifikante Unterschiede in Bezug auf den postprozeduralen Durchfluss des Grads 2 und 3 gemäß TIMI-Klassifikation („thrombolysis in myocardial infarction“; p = 0,021 bzw. p = 0,006). In Gruppe A war die Inzidenz eines langsamen Flusses signifikant niedriger als in Gruppe B (p = 0,011). Es wurde eine erhöhte Inzidenz einer fehlenden Rückbildung der ST-Strecken-Hebung in Gruppe B (p = 0,011) beobachtet. In Gruppe A gab es weniger MACE als in Gruppe B, der Unterschied war jedoch statistisch nicht signifikant.

Schlussfolgerung

Die selektive Tirofibaninjektion via TA-Katheter während PPCI führt möglicherweise zu einer besseren Myokardreperfusion bei Patienten mit STEMI und hoher Thrombuslast.

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Acknowledgements

This study is supported by Panyu Central Hospital (Cardiovascular Institute of Panyu District), Guangzhou Medical and Health Science and Technology General Guidance Project (No. 20171A011352) and Youth Research Funds of Panyu Central Hospital (2016–10). We thank Professor Mingcai Song and Guoqin Chen (Cardiovascular Institute of Panyu District) for their valuable advice and assistance.

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Authors and Affiliations

  1. Department of Cardiology, Panyu Central Hospital (Cardiovascular Institute of Panyu District), 511400, Guangzhou, China

    Z. Zhang, W. Wu, Q. Xie, J. Li & W. Zhang

  2. Department of Cardiology, Ganzhou City People’s Hospital, 341000, Ganzhou, China

    W. Li

  3. Department of Ultrasound, Guangdong Women and Children Hospital, No. 521 Xingnan Avenue, 511400, Guangzhou, China

    Y. Zhang

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Z. Zhang, W. Li, W. Wu, Q. Xie, J. Li, W. Zhang, and Y. Zhang declare that they have no competing interests.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Zhang, Z., Li, W., Wu, W. et al. Myocardial reperfusion with tirofiban injection via aspiration catheter. Herz 45, 280–287 (2020). https://doi.org/10.1007/s00059-018-4716-0

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