Tian Rui, Liu Rugang, Zhang Jiajun, Li Yong, Wei Shujian, Xu Feng, Li Xiaoxing, Li Chuanbao
Department of Emergency Medicine and Chest Pain Center, Qilu Hospital of Shandong University, Jinan, Shandong, China.
Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital of Shandong University, Jinan, Shandong, China.
Heliyon. 2023 Apr 28;9(5):e15842. doi: 10.1016/j.heliyon.2023.e15842. eCollection 2023 May.
Effective antiplatelet therapy is critical for patients with ST-segment elevation myocardial infarction (STEMI) and receiving primary percutaneous coronary interventions (PPCI). Intracoronary (IC) and intravenous (IV) administration of tirofiban are commonly used during the procedure of PPCI. However, which is the better administration route of tirofiban have not been fully evaluated.
A comprehensive literature search of RCTs that comparing IC with IV tirofiban in STEMI patients undergoing PPCI was conducted, which were published as of May 7, 2022, in PubMed, Embase, Cochrane Library, Web of Science, Scopus and ClinicalTrials.gov. The primary efficacy endpoint was 30-day major adverse cardiovascular events (MACE) and the primary safety endpoint was in-hospital bleeding events.
This meta-analysis included 9 trials involving 1177 patients. IC tirofiban significantly reduced the incidence of 30-day MACE (RR 0.65, 95% CI: 0.44 to 0.95, P = 0.028) and improved the rate of the thrombolysis in myocardial infarction (TIMI) grade 3 flow in high-dose (25 μg/kg) group (RR = 1.13, 95% CI: 0.99-1.30, P = 0.001), in-hospital (WMD 2.03, 95% CI: 1.03 to 3.02, P < 0.001), and 6-month left ventricular injection fraction (LVEF) (WMD 6.01, 95% CI: 5.02 to 6.99, P < 0.001) compared with IV. There was no significant difference in the incidences of in-hospital bleeding events (RR 0.96, 95% CI: 0.67 to 1.38, P = 0.82) and thrombocytopenia (RR 0.63, 95% CI: 0.26 to 1.57, P = 0.32) between the two groups.
IC tirofiban significantly improved the incidence of TIMI 3 in the high-dose group, in-hospital and 6-month LVEF, and reduced the 30-day MACE incidence without increasing the risk of bleeding compared with IV.
有效的抗血小板治疗对于ST段抬高型心肌梗死（STEMI）且接受直接经皮冠状动脉介入治疗（PPCI）的患者至关重要。在PPCI过程中，冠状动脉内（IC）和静脉内（IV）给予替罗非班是常用的方法。然而，替罗非班哪种给药途径更好尚未得到充分评估。
对截至2022年5月7日在PubMed、Embase、Cochrane图书馆、科学网、Scopus和ClinicalTrials.gov上发表的比较IC与IV替罗非班用于接受PPCI的STEMI患者的随机对照试验（RCT）进行全面文献检索。主要疗效终点是30天主要不良心血管事件（MACE），主要安全终点是住院期间出血事件。
该荟萃分析纳入了9项试验，涉及1177例患者。与IV相比，IC替罗非班显著降低了30天MACE的发生率（风险比[RR]0.65，95%置信区间[CI]：0.44至0.95，P = 0.028），并提高了高剂量（25μg/kg）组心肌梗死溶栓（TIMI）3级血流率（RR = 1.13，95%CI：0.99 - 1.30，P = 0.001）、住院期间（加权均数差[WMD]2.03，95%CI：1.03至3.02，P < 0.001）以及6个月左心室射血分数（LVEF）（WMD 6.01，95%CI：5.02至6.99，P < 0.001）。两组住院期间出血事件发生率（RR 0.96，95%CI：0.67至1.38，P = 0.82）和血小板减少症发生率（RR 0.63，95%CI：0.26至1.57，P = 0.32）无显著差异。
与IV相比，IC替罗非班显著提高了高剂量组的TIMI 3级发生率、住院期间及6个月的LVEF，并降低了30天MACE发生率，且未增加出血风险。
