Changes in BNP, hs-CRP and TIMI risk index with addition of tirofiban during primary percutaneous coronary intervention for acute STEMI: a prospective observational cohort study

Abstract

This study aimed to investigate the relationship of tirofiban, added to the treatment of acute ST-elevation myocardial infarction (STEMI) patients underwent primary percutaneous coronary intervention (PCI), with changes in the TIMI risk index (TRI) of TIMI flow, B-type natriuretic peptide (BNP) and high-sensitive C-reactive protein (hs-CRP) levels. This single-center, prospective observational cohort study included 102 consecutive patients who were admitted with the diagnosis of acute STEMI (70 male; 54.9±10.4 years). Primary PCI was applied to all cases with STEMI, who applied to our hospital in the first 6 hours due to chest pain complaints. Tirofiban was administered to one group (n=55) (male: 36; 54.1±11.3 years), while the other group was not given tirofiban (n=47) (male: 34; 55.9±9.1 years). The primary end-point was TIMI flow 2 or 3 for reperfusion after primary PCI. Chi-square test, paired t-test or Wilcoxon signed rank test, Spearman correlation analysis and Kaplan-Meier survival analysis were used for statistical analysis where appropriate. BNP level remained the same in the tirofiban group, whereas a significant increase was observed in the group that was not treated with tirofiban (105.9±126.8 versus 261.3±202.3 pg/ml p<0.001). The hs-CRP level tended to rise significantly in both groups despite the treatment (tirofiban group - from 0.67±0.66 to 0.90±0.44 mg/L, p=0.015, non tirofiban group - from 0.51±0.43 to 1.08±0.74 mg/L, p<0.001). BNP and hs-CRP values remained the same in cases with TIMI 2 flow in the tirofiban group, whereas a significant increase was detected in the post-treatment BNP (before 97.8±122.3 after 281.6±217.3 pg/ml, p=0.011) and hs-CRP (before 0.65±0.69; after 1.33±0.80 mg/L, p=0.028) values in the group not treated with tirofiban. In patients with TIMI 3 flow, BNP (tirofiban group before 146.5±114.2; after 184.4±139.4 pg/ml, p=0.011, non tirofiban group before 172.1±297.9; after 295.9±384.9 pg/ml, p<0.001) and hs-CRP levels (tirofiban group before 0.66±0.58; after 0.92±0.65 mg/L, p=0.011, non tirofiban group before 0.81±0.74; after 1.45±1.23 mg/L, p<0.001) were found to be similarly reduced in both treatment groups p<0.05. Three patients with minor hemorrhage did not need blood transfusion. It was concluded at the end of them PCI application in STEMI that the addition of tirofiban treatment in patients with ≥TIMI 2 flow and anterior location MI could decrease the expected rise in BNP and CRP values.