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Tytuł:
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Intracoronary compared with intravenous bolus tirofiban on the microvascular obstruction in patients with STEMI undergoing PCI: a cardiac MR study.
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Autorzy:
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Ma Q; Department of Radiology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, 110004, Liaoning, People's Republic of China.
Ma Y; Department of Radiology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, 110004, Liaoning, People's Republic of China.
Wang X; Department of Radiology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, 110004, Liaoning, People's Republic of China.
Li S; Department of Radiology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, 110004, Liaoning, People's Republic of China.
Yu T; Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China.
Duan W; Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China.
Wu J; Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China.
Wen Z; Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China.
Jiao Y; Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China.
Sun Z; Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China.
Hou Y; Department of Radiology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, 110004, Liaoning, People's Republic of China. houyang_.
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Źródło:
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The international journal of cardiovascular imaging [Int J Cardiovasc Imaging] 2020 Jun; Vol. 36 (6), pp. 1121-1132. Date of Electronic Publication: 2020 Feb 20.
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Typ publikacji:
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Comparative Study; Journal Article; Randomized Controlled Trial
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Język:
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English
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Imprint Name(s):
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Publication: [New York] : Springer
Original Publication: Boston : Kluwer Academic Publishers, c2001-
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MeSH Terms:
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Magnetic Resonance Imaging, Cine*
Percutaneous Coronary Intervention*/adverse effects
Percutaneous Coronary Intervention*/mortality
Coronary Circulation/*drug effects
Microcirculation/*drug effects
Myocardial Reperfusion Injury/*prevention & control
Platelet Aggregation Inhibitors/*administration & dosage
ST Elevation Myocardial Infarction/*therapy
Tirofiban/*administration & dosage
Administration, Intravenous ; Adult ; China ; Female ; Humans ; Male ; Middle Aged ; Myocardial Reperfusion Injury/diagnostic imaging ; Myocardial Reperfusion Injury/mortality ; Myocardial Reperfusion Injury/physiopathology ; Platelet Aggregation Inhibitors/adverse effects ; Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors ; Predictive Value of Tests ; Prospective Studies ; ST Elevation Myocardial Infarction/diagnostic imaging ; ST Elevation Myocardial Infarction/mortality ; ST Elevation Myocardial Infarction/physiopathology ; Time Factors ; Tirofiban/adverse effects ; Treatment Outcome ; Ventricular Function, Left/drug effects ; Ventricular Remodeling/drug effects
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Contributed Indexing:
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Keywords: Acute myocardial infarction; Glycoprotein IIb/IIIa inhibitor; Magnetic resonance imaging; Microvascular obstruction; Tirofiban
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Substance Nomenclature:
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0 (Platelet Aggregation Inhibitors)
0 (Platelet Glycoprotein GPIIb-IIIa Complex)
GGX234SI5H (Tirofiban)
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Entry Date(s):
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Date Created: 20200221 Date Completed: 20200921 Latest Revision: 20200921
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Update Code:
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20240105
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DOI:
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10.1007/s10554-020-01800-0
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PMID:
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32078096
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To investigate the potential effect of intracoronary administration of the glycoprotein IIb/IIIa inhibitor tirofiban on the microvascular obstruction (MVO) assessed by cardiac magnetic resonance (CMR) imaging compared to the intravenous route in patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI). Two hundred eight patients were randomized into two groups (tirofiban i.v. and tirofiban i.c.). CMR was completed within 3-7 days after ST-segment-elevation myocardial infarction. One hundred thirty-two patients had a follow-up CMR at 6 months after discharge. The primary end point was the CMR measurements including myocardium strain, myocardial perfusion index, final infarct size, prevalence and extent of MVO, and the change of left ventricular end-diastolic volume (LVEDV) at six months follow-up. The second endpoint was major adverse cardiovascular events (composite of all-cause death, nonfatal reinfarction and congestive heart failure) in one year. The MVO prevalence and extent [56% versus 36%, p = 0.004; 2.08 (IQR: 1.18-5.07) g versus 1.68 (IQR: 0.30-3.28) g, p = 0.041] showed a significant difference between the intravenous and intracoronary groups. Global left ventricular peak longitudinal strain was significantly different in intracoronary groups compared to intravenous groups, - 12.5 [IQR: - 13.4 to - 10.9] versus - 12.3 [IQR: - 13.4 to - 10.4], respectively (P = 0.042). Infarcted myocardial perfusion index was significantly different in intracoronary groups compared to intravenous groups, 0.11 [IQR: 0.08 to 0.15] versus 0.09 [IQR: 0.07 to 0.14], respectively (P = 0.026). Intracoronary tirofiban was associated with a higher change in LVEDV compared with intravenous group (- 10.2% [IQR: - 13.7% to - 2.6%] versus 1.3% [IQR: - 5.6% to 6.1%], p < 0.001). Intracoronary tirofiban application showed no benefit on the occurrence of major adverse cardiovascular events during follow-up compared to intravenous administration. This CMR study in ST-segment-elevation myocardial infarction patients showed a benefit in MVO and left ventricular remodeling for intracoronary tirofiban administration compared to intravenous administration in patients undergoing PCI.
