Intracoronary Versus Intravenous Administration of Glycoprotein IIb/IIIa inhibitors in Diabetic Patients Undergoing Primary Percutaneous Coronary Intervention

Abstract

Background: Previous trials remained inconsistent regarding benefits and possible risks associated with intracoronary (IC) administration compared with intravenous (IV) are still questionable. We aimed at evaluation safety and effectiveness of IC versus IV tirofiban administration during primary percutaneous coronary intervention (PCI) for diabetic patients (DM) presented with acute ST segment elevation myocardial infarction. Methods: This trial included 100 patients who were randomized either IV high bolus plus maintenance or IC high bolus plus maintenance of tirofiban. Both groups were compared for pre and post intervention for myocardial perfusion, cardiac marker and Major composite adverse cardiac event incidence at 30 days were recorded. Results: Incidence of major adverse cardiac events was not different between groups, but Post procedure TIMI flow III and MBG III were significant in IC group with p = 0.45, and 0.21 respectively favoring intracoronary strategy. Peak CK-MB values were lower in IC tirofiban group than IV group, 155.68 ± 121, 192.4 ± 86 respectively with significant (p=0.021). Peak hs-TnT value was significantly were lower in IC tirofiban group [4291 ± 334 ng/dL vs 5342 ± 286 ng/dL in IV group; (p=0.035). ST segment resolution and 30 days LVEF in IC group were significantly higher in IC group than in IV group (p= 0.023) respectively. Conclusion: IC GpIIb/IIIa inhibitors is more effective in improving coronary blood flow and myocardial tissue perfusion in DM after STEMI 30 days post PCI despite the bleeding event and MACE rates showed no significant difference,IC tirofiban group, showed better improvement in LVEF.