Login Register Cart 0
Generic placeholder image

Current Vascular Pharmacology

Editor-in-Chief

ISSN (Print): 1570-1611
ISSN (Online): 1875-6212

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Research Article

Effects of Tirofiban in Patients with Acute Myocardial Infarction and Diabetes Mellitus undergoing Primary Percutaneous Coronary Intervention

Author(s): Xiuying Tang* and Runjun Li

Volume 22, Issue 1, 2024

Published on: 18 October, 2023

Page: [41 - 49] Pages: 9

DOI: 10.2174/0115701611251882231012080210

Price: $65

conference banner
Abstract

Objective: This study evaluated the efficacy and safety of early vs. late tirofiban administration in the treatment of patients with acute ST-elevation myocardial infarction (STEMI) and diabetes mellitus (DM) undergoing primary percutaneous coronary intervention (pPCI).

Methods: 120 patients with STEMI and DM treated with pPCI were randomly divided into an observation group (n=60) and a control group (n=60). The observation group and the control group were intravenously injected with a bolus of tirofiban preoperatively or intraoperatively, respectively; both groups were then given an intravenous infusion over 24 h at 0.15 μg/kg/min. Thrombolysis in myocardial infarction (TIMI) grade flow, myocardial perfusion index, and functional heart parameters, as well as major adverse cardiovascular events and bleeding, were compared between the two groups.

Results: Functional heart parameters, including left ventricular ejection fraction and cardiac output, were significantly improved in the observation group 6 months after discharge. Thrombus aspiration, inflammatory factors, and cardiac troponin I (cTNI) were more significantly decreased in the observation group than in the control group. The sum-ST-segment elevation at 2 h after pPCI treatment in the observation group was better than that in the control group. There was no significant difference in the incidence of adverse reactions and bleeding between the two groups.

Conclusion: The administration of tirofiban before reperfusion therapy compared with after reperfusion therapy is more effective in reducing the hyperthrombotic load, thrombus aspiration, inflammatory factors, and cTNI and can effectively improve myocardial perfusion and heart function.

Keywords: Acute myocardial infarction, myocardial perfusion index, thrombus aspiration, tirofiban, heart function, inflammatory factors.

« Previous Next »
[1]
Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2018; 39(2): 119-77.
[http://dx.doi.org/10.1093/eurheartj/ehx393] [PMID: 28886621]
[2]
Szummer K, Wallentin L, Lindhagen L, et al. Improved outcomes in patients with ST-elevation myocardial infarction during the last 20 years are related to implementation of evidence-based treatments: Experiences from the SWEDEHEART registry 1995–2014. Eur Heart J 2017; 38(41): 3056-65.
[http://dx.doi.org/10.1093/eurheartj/ehx515] [PMID: 29020314]
[3]
Pryds K, Hjortbak MV, Schmidt MR. Influence of Cardiovascular Risk Factors, Comorbidities, Medication Use and Procedural Variables on Remote Ischemic Conditioning Efficacy in Patients with ST-Segment Elevation Myocardial Infarction. Int J Mol Sci 2019; 20(13): 3246.
[http://dx.doi.org/10.3390/ijms20133246] [PMID: 31269650]
[4]
Anderson JL, Morrow DA. Acute Myocardial Infarction. N Engl J Med 2017; 376(21): 2053-64.
[http://dx.doi.org/10.1056/NEJMra1606915] [PMID: 28538121]
[5]
de Boer SPM, Barnes EH, Westerhout CM, et al. High-risk patients with ST-elevation myocardial infarction derive greatest absolute benefit from primary percutaneous coronary intervention: Results from the Primary Coronary Angioplasty Trialist versus Thrombolysis (PCAT)-2 Collaboration. Am Heart J 2011; 161(3): 500-507.e1.
[http://dx.doi.org/10.1016/j.ahj.2010.11.022] [PMID: 21392604]
[6]
Henning RJ. Type-2 diabetes mellitus and cardiovascular disease. Future Cardiol 2018; 14(6): 491-509.
[http://dx.doi.org/10.2217/fca-2018-0045] [PMID: 30409037]
[7]
Milazzo V, Cosentino N, Genovese S, et al. Diabetes Mellitus and Acute Myocardial Infarction: Impact on Short and Long-Term Mortality. Adv Exp Med Biol 2020; 1307: 153-69.
[http://dx.doi.org/10.1007/5584_2020_481] [PMID: 32020518]
[8]
Sans S. Metabolic syndrome and diabetes in post-acute myocardial infarction patients. Eur J Prev Cardiol 2018; 25(8): 826-9.
[http://dx.doi.org/10.1177/2047487318772394] [PMID: 29671614]
[9]
Shao C, Wang J, Tian J, Tang Y. Coronary Artery Disease: From Mechanism to Clinical Practice. Adv Exp Med Biol 2020; 1177: 1-36.
[http://dx.doi.org/10.1007/978-981-15-2517-9_1] [PMID: 32246442]
[10]
Echouffo-Tcheugui JB, Kolte D, Khera S, et al. Diabetes Mellitus and Cardiogenic Shock Complicating Acute Myocardial Infarction. Am J Med 2018; 131(7): 778-786.e1.
[http://dx.doi.org/10.1016/j.amjmed.2018.03.004] [PMID: 29596788]
[11]
Kim YH, Her AY, Jeong MH, et al. Which is the worst risk factor for the long-term clinical outcome? Comparison of long-term clinical outcomes between antecedent hypertension and diabetes mellitus in South Korean acute myocardial infarction patients after stent implantation. J Diabetes 2020; 12(2): 119-33.
[http://dx.doi.org/10.1111/1753-0407.12979] [PMID: 31420948]
[12]
Capodanno D, Milluzzo RP, Angiolillo DJ. Intravenous antiplatelet therapies (glycoprotein IIb/IIIa receptor inhibitors and cangrelor) in percutaneous coronary intervention: From pharmacology to indications for clinical use. Ther Adv Cardiovasc Dis 2019; 13.
[http://dx.doi.org/10.1177/1753944719893274] [PMID: 31823688]
[13]
Dornbos D III, Katz JS, Youssef P, Powers CJ, Nimjee SM. Glycoprotein IIb/IIIa Inhibitors in Prevention and Rescue Treatment of Thromboembolic Complications During Endovascular Embolization of Intracranial Aneurysms. Neurosurgery 2018; 82(3): 268-77.
[http://dx.doi.org/10.1093/neuros/nyx170] [PMID: 28472526]
[14]
Karathanos A, Lin Y, Dannenberg L, et al. Routine Glycoprotein IIb/IIIa Inhibitor Therapy in ST-Segment Elevation Myocardial Infarction: A Meta-analysis. Can J Cardiol 2019; 35(11): 1576-88.
[http://dx.doi.org/10.1016/j.cjca.2019.05.003] [PMID: 31542257]
[15]
Tomasik A, Nabrdalik K, Kwiendacz H, et al. Effect of Diabetes Mellitus and Left Ventricular Perfusion on Frequency of Development of Heart Failure and/or All-cause Mortality Late After Acute Myocardial Infarction. Am J Cardiol 2021; 140: 25-32.
[http://dx.doi.org/10.1016/j.amjcard.2020.10.051] [PMID: 33144164]
[16]
Shen J, Zhang Q, Zhang RY, et al. Clinical benefits of adjunctive tirofiban therapy in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Coron Artery Dis 2008; 19(4): 271-7.
[http://dx.doi.org/10.1097/MCA.0b013e3282f487e0] [PMID: 18480672]
[17]
Tang X, Li R, Jing Q, Liu Y, Liu P. Efficacy and Safety of IntracoronaryversusIntravenous Administration of Tirofiban during Percutaneous Coronary Intervention for Acute Coronary Syndrome: A Meta-Analysis of Randomized Controlled Trials. PLoS One 2015; 10(6): e0129718.
[http://dx.doi.org/10.1371/journal.pone.0129718] [PMID: 26067296]
[18]
Ma Q, Ma Y, Wang X, et al. Intracoronary compared with intravenous bolus tirofiban on the microvascular obstruction in patients with STEMI undergoing PCI: A cardiac MR study. Int J Cardiovasc Imaging 2020; 36(6): 1121-32.
[http://dx.doi.org/10.1007/s10554-020-01800-0] [PMID: 32078096]
[19]
Tang X, Li R, Zhang T. Comparison of intracoronary versus intravenous tirofiban in acute ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. Coron Artery Dis 2022; 33(7): 547-52.
[http://dx.doi.org/10.1097/MCA.0000000000001177] [PMID: 35942633]
[20]
Cosentino F, Grant PJ, Aboyans V, et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J 2020; 41(2): 255-323.
[http://dx.doi.org/10.1093/eurheartj/ehz486] [PMID: 31497854]
[21]
Wang H, Feng M. Influences of different dose of tirofiban for acute ST elevation myocardial infarction patients underwent percutaneous coronary intervention. Medicine (Baltimore) 2020; 99(23): e20402.
[http://dx.doi.org/10.1097/MD.0000000000020402] [PMID: 32501985]
[22]
Bainey KR, Armstrong PW, Zheng Y, et al. Pharmacoinvasive Strategy versus Primary Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction in Clinical Practice. Circ Cardiovasc Interv 2019; 12(10): e008059.
[http://dx.doi.org/10.1161/CIRCINTERVENTIONS.119.008059] [PMID: 31607152]
[23]
GUSTO investigators. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med 1993; 329(10): 673-82.
[http://dx.doi.org/10.1056/NEJM199309023291001] [PMID: 8204123]
[24]
Meneveau N, Souteyrand G, Motreff P, et al. Optical Coherence Tomography to Optimize Results of Percutaneous Coronary Intervention in Patients with Non–ST-Elevation Acute Coronary Syndrome. Circulation 2016; 134(13): 906-17.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.116.024393] [PMID: 27573032]
[25]
Schulz-Schüpke S, Byrne RA, ten Berg JM, et al. ISAR-SAFE: A randomized, double-blind, placebo-controlled trial of 6 vs. 12 months of clopidogrel therapy after drug-eluting stenting. Eur Heart J 2015; 36(20): 1252-63.
[http://dx.doi.org/10.1093/eurheartj/ehu523] [PMID: 25616646]
[26]
Liang T, Liu M, Wu C, Zhang Q, Lu L, Wang Z. Risk Factors for No-Reflow Phenomenon after Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome. Rev Invest Clin 2017; 69(3): 139-45.
[http://dx.doi.org/10.24875/RIC.17002190] [PMID: 28613283]
[27]
Zhou J, Xu J, Cheng A, Li P, Chen B, Sun S. Effect of nicorandil treatment adjunctive to percutaneous coronary intervention in patients with acute myocardial infarction: A systematic review and meta-analysis. J Int Med Res 2020; 48(11)
[http://dx.doi.org/10.1177/0300060520967856] [PMID: 33249959]
[28]
Heusch G. Myocardial ischaemia–reperfusion injury and cardioprotection in perspective. Nat Rev Cardiol 2020; 17(12): 773-89.
[http://dx.doi.org/10.1038/s41569-020-0403-y] [PMID: 32620851]
[29]
Heusch G. Coronary microvascular obstruction: The new frontier in cardioprotection. Basic Res Cardiol 2019; 114(6): 45.
[http://dx.doi.org/10.1007/s00395-019-0756-8] [PMID: 31617010]
[30]
Maznyczka AM, Oldroyd KG, Greenwood JP, et al. Comparative Significance of Invasive Measures of Microvascular Injury in Acute Myocardial Infarction. Circ Cardiovasc Interv 2020; 13(5): e008505.
[http://dx.doi.org/10.1161/CIRCINTERVENTIONS.119.008505] [PMID: 32408817]
[31]
Marc MC, Iancu AC, Bãlãnescu S, Dregoesc MI. Microvascular obstruction in acute myocardial infarction: An old and unsolved mystery. Med Pharm Rep 2019; 92(3): 216-9.
[http://dx.doi.org/10.15386/mpr-1261] [PMID: 31460500]

Rights & Permissions Print Cite
Article Metrics
30
2
Wayfinder Image
World Prematurity Day
© 2024 Bentham Science Publishers | Privacy Policy