Abstract
Background
Primary percutaneous coronary intervention (PCI) is more effective than fibrinolytic therapy for ST‐segment elevation myocardial infarction (STEMI), but initial treatment delay to intervention is the main limitation of this strategy. Hypothesis: Upstream use of high‐dose tirofiban could reduce myocardial infarct size, using analysis of contrast‐enhanced magnetic resonance imaging (CE‐MRI).
Methods
Patients with STEMI within 12 hours after symptom onset were randomized to a facilitated PCI group (n = 19) or to a primary PCI group (n = 20). The primary endpoint was myocardial infarct size evaluated by the volume of delayed hyperenhancement on CE‐MRI at 1 month after index procedure.
Results
The baseline clinical characteristics were not significantly different between the 2 groups. Although the incidence of pre‐PCI thrombolysis in myocardial infarction (TIMI) flow grade 2 to 3 was significantly higher in the facilitated PCI group than in the primary PCI group (47.4% vs 15.0%, P = 0.03), the achievement of myocardial blush grade 2 to 3 or ST‐segment resolution at 30 minutes after procedure was not significantly different between the facilitated PCI and the primary PCI group (36.8% vs 40%, P = 0.84 and 31.6% vs 20%, P = 0.41, respectively). Infarct size on CE‐MRI was similar in the facilitated PCI group and the conventional primary PCI group (22.1% ± 11.7% vs 25.2% ± 13.2%, P = 0.44). At 6 months, the left ventricular ejection fraction (LVEF) on echocardiography was 52.6% ± 10.4% in the facilitated PCI group and 50.9% ± 9.8% in the primary PCI group (P = 0.68).
Conclusion
Despite the improvement of initial TIMI flow grade, the upstream use of high‐dose tirofiban did not reduce myocardial infarct size measured by CE‐MRI. Copyright © 2009 Wiley Periodicals, Inc.
Full Text
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