Tang Xiuying, Li Runjun, Jing Quanmin, Liu Yingfeng, Liu Peng
Department of Cardiology, The first hospital of QinHuangDao, QinHuangDao, HeBei, China.
Department of Emergency Medicine, The first hospital of QinHuangDao, QinHuangDao, HeBei, China.
PLoS One. 2015 Jun 11;10(6):e0129718. doi: 10.1371/journal.pone.0129718. eCollection 2015.
Percutaneous coronary intervention (PCI) is known as the most effective treatment for acute coronary syndrome (ACS). However, without proper therapy and patient management, stent thrombosis after PCI may lead to another myocardial infarction. In addition to aspirin and clopidogrel, tirofiban is often used as an antiplatelet therapy in patients with ACS. To date, there has been no comprehensive evaluation of the efficacy and safety of intracoronary (IC) tirofiban administration for ACS patients undergoing PCI compared with intravenous (IV) administration. Therefore, this meta-analysis was conducted to investigate the clinical efficiency and safety of IC versus intravenous (IV) tirofiban in ACS patients undergoing PCI.
We searched PubMed and Medline for randomized controlled trials (RCTs) comparing IC versus IV administration of tirofiban in ACS patients undergoing PCI. We evaluated the effects of tirofiban on thrombolysis in myocardial infarction (TIMI) grade 3 flow after PCI, TIMI myocardial perfusion grade 3 (TMP grade 3), left ventricular ejection fraction (LVEF), major adverse cardiovascular events (MACE), target vessel revascularization (TVR), death, reinfarction and adverse drug effects (specifically bleeding events).
Seven trials involving 1,027 patients were included in this meta-analysis. IC administration of tirofiban significantly increased TIMI grade 3 flow (OR 2.11; 95% CI 1.02 to 4.37; P = 0.04) and TMP grade 3 (OR 2.67; 95% CI 1.09 to 6.49; P = 0.03, I2 = 64%) while reducing MACE (OR 0.46, 95% CI: 0.28 to 0.75; P = 0.002) compared with IV administration of tirofiban. No significant differences were observed in the occurrence of TVR, death, reinfarction and the incidence of bleeding events between the two groups.
This meta-analysis supports the use of IC over IV administration of tirofiban in patients with ACS to improve TIMI flow, TMP flow and MACE. However, there was no statistically significant difference in the risk of bleeding complications between the two groups.
经皮冠状动脉介入治疗（PCI）是急性冠状动脉综合征（ACS）最有效的治疗方法。然而，若没有适当的治疗和患者管理，PCI术后支架血栓形成可能会导致再次心肌梗死。除阿司匹林和氯吡格雷外，替罗非班常用于ACS患者的抗血小板治疗。迄今为止，与静脉注射（IV）相比，对于接受PCI的ACS患者冠状动脉内（IC）给予替罗非班的疗效和安全性尚无全面评估。因此，进行这项荟萃分析以研究IC与IV给予替罗非班在接受PCI的ACS患者中的临床疗效和安全性。
我们在PubMed和Medline上检索了比较IC与IV给予替罗非班在接受PCI的ACS患者中的随机对照试验（RCT）。我们评估了替罗非班对PCI术后心肌梗死溶栓（TIMI）3级血流、TIMI心肌灌注3级（TMP 3级）、左心室射血分数（LVEF）、主要不良心血管事件（MACE）、靶血管血运重建（TVR）、死亡、再梗死和不良药物反应（特别是出血事件）的影响。
本荟萃分析纳入了7项涉及1027例患者的试验。与IV给予替罗非班相比，IC给予替罗非班显著增加TIMI 3级血流（比值比[OR] 2.11；95%置信区间[CI] 1.02至4.37；P = 0.04）和TMP 3级（OR 2.67；95% CI 1.09至6.49；P = 0.03，I² = 64%），同时降低MACE（OR 0.46，95% CI：0.28至0.75；P = 0.002）。两组在TVR、死亡、再梗死的发生率以及出血事件的发生率方面未观察到显著差异。
这项荟萃分析支持在ACS患者中使用IC给予替罗非班而非IV给予，以改善TIMI血流、TMP血流和MACE。然而，两组在出血并发症风险方面无统计学显著差异。
