The Effects Of Tirofeban Administrated At Various Time Points On No-reflow Phenomenon During Percutaneous Coronary Intervention

Objective To compare the effects of intracoronary bolus injection of tirofeban at various time points on the intraprocedural blood flow and short-term prognosis in patients with acute coronary syndrome in whom no-reflow occurs in percutaneous coronary intervention(PCI).Methods 128 patients who had no-reflow due to acute thrombosis during PCI were selected.No-reflow was defined as TIMI(thrombolysis in myocardial infarction)grade 0 of the antegrade blood flow due to acute thrombosis in target vessels during PIC.Patients were randomized into 2 groups with 64 cases in each group.Group A:Tirofeban was injected via guiding catheter when TIMI grade was ≥ 1 after passing-through of guidewire,balloon or pre-dilatation of balloon, or injection via microcatheter when there was no antegrade flow after aforementioned management; Group B:Tirofeban was directly injected via guiding catheter when noreflow occurred.Dosage was 10 ug/kg in both groups and injection was completed in about 3 minutes.Consequently continuous infusion of tirofeban infusion with 0.15 ug/(kg.min) was maintained for 36 hours by micro pump. Immediate blood flow in target vessel after PCI, improvement of symptoms 3 days after procedure as well as 30-day major adverse cardiovascular events(MACE) were assessed.Results Intraprocedural blood flow recovery and symptom improvement 3 days after procedure were better in Group A than in Group B with statistical significance(P<0.05);The incidence of 30 major adverse cardiovascular events was lower in Group A than in Group B with statistical significance(P<0.05).Conclusion if no-reflow occurs in PCI,injection of tirofeban via guiding catheter when TIMI grade is ≥ 1 after passing-through of guidewire, balloon or pre-dilatation of balloon, or injection via microcatheter when there is no antegrade flow after aforementioned management,may reverse no-reflow,reduce symptomatic discomfort as well as lower short-term MACE incidence more than does direct injection of tirofeban via guiding catheter when there is no antegrade flow.