Limits...
Efficacy and Safety of Intracoronary versus Intravenous Administration of Tirofiban during Percutaneous Coronary Intervention for Acute Coronary Syndrome: A Meta-Analysis of Randomized Controlled Trials.

Tang X, Li R, Jing Q, Liu Y, Liu P - PLoS ONE (2015)

Bottom Line: Percutaneous coronary intervention (PCI) is known as the most effective treatment for acute coronary syndrome (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.However, there was no statistically significant difference in the risk of bleeding complications between the two groups.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, The first hospital of QinHuangDao, QinHuangDao, HeBei, China.

ABSTRACT

Background: 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.

Methods: 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).

Results: 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.

Conclusions: 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.

No MeSH data available.


Related in: MedlinePlus

Forest plot for endpoints in STEMI patients treated with IC vs. IV administration of tirofiban.(A). Forest plot for TIMI grade 3 flow based on a random-effects model in STEMI patients treated with IC vs. IV administration of tirofiban. (B). Forest plot for TMP grade 3 based on a random-effects model in STEMI patients treated with IC vs. IV administration of tirofiban. (C). Forest plot for in-hospital LVEF based on a random-effects model in STEMI patients treated with IC vs. IV administration of tirofiban. (D). Forest plot for medium-term LVEF based on a random-effects model in STEMI patients treated with IC vs. IV administration of tirofiban. (E). Forest plot for TVR based on a fixed-effects model in STEMI patients treated with IC vs. IV administration of tirofiban. (F). Forest plot for death based on a fixed-effects model in STEMI patients treated with IC vs. IV administration of tirofiban. (G). Forest plot for reinfarction based on a fixed-effects model in STEMI patients treated with IC vs. IV administration of tirofiban. (H). Forest plot for bleeding events based on a fixed-effects model in STEMI patients treated with IC vs. IV administration of tirofiban. (I). Forest plot for MACE based on fixed-effects model in STEMI patients treated with IC vs. IV administration of tirofiban.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4465926&req=5

pone.0129718.g008: Forest plot for endpoints in STEMI patients treated with IC vs. IV administration of tirofiban.(A). Forest plot for TIMI grade 3 flow based on a random-effects model in STEMI patients treated with IC vs. IV administration of tirofiban. (B). Forest plot for TMP grade 3 based on a random-effects model in STEMI patients treated with IC vs. IV administration of tirofiban. (C). Forest plot for in-hospital LVEF based on a random-effects model in STEMI patients treated with IC vs. IV administration of tirofiban. (D). Forest plot for medium-term LVEF based on a random-effects model in STEMI patients treated with IC vs. IV administration of tirofiban. (E). Forest plot for TVR based on a fixed-effects model in STEMI patients treated with IC vs. IV administration of tirofiban. (F). Forest plot for death based on a fixed-effects model in STEMI patients treated with IC vs. IV administration of tirofiban. (G). Forest plot for reinfarction based on a fixed-effects model in STEMI patients treated with IC vs. IV administration of tirofiban. (H). Forest plot for bleeding events based on a fixed-effects model in STEMI patients treated with IC vs. IV administration of tirofiban. (I). Forest plot for MACE based on fixed-effects model in STEMI patients treated with IC vs. IV administration of tirofiban.

Mentions: Sensitivity analyses of the RCTs [29,31–35] were conducted to evaluate the efficacy and safety of IC versus IV tirofiban in patients with ST-elevation myocardial infarction (STEMI) undergoing PCI. However, in the cases with STEMI and PCI, although no significant differences were detected between the effects of an IC or IV tirofiban bolus on complete perfusion after PCI [29,31–35], TMP grade 3 [29,31,33,35], in-hospital LVEF [29,32–34] and medium-term follow-up LVEF [33–35], TVR [31–35], death [29,31,32,34,35], reinfarction [29,31,32,34,35], and bleeding events [29,31,33–35] (P = 0.12, P = 0.16, P = 0.05 and P = 0.61, P = 0.15, P = 0.11, P = 0.51, and P = 0.88, respectively), the pooled data [29,32,34,35] with a fixed-effects model showed that MACE was significantly reduced by IC tirofiban in STEMI patients compared with IV administration (OR 0.48; 95% CI 0.29 to 0.80; P = 0.004, I2 = 36%, heterogeneity P = 0.20). All of the analysis outcomes are detailed in Fig 8. The outcomes regarding MACE based on a random-effects model were also consistent with the above main analyses, and none of the Funnel plot analyses addressing the above outcomes suggested the presence of publication bias.


Efficacy and Safety of Intracoronary versus Intravenous Administration of Tirofiban during Percutaneous Coronary Intervention for Acute Coronary Syndrome: A Meta-Analysis of Randomized Controlled Trials.

Tang X, Li R, Jing Q, Liu Y, Liu P - PLoS ONE (2015)

Forest plot for endpoints in STEMI patients treated with IC vs. IV administration of tirofiban.(A). Forest plot for TIMI grade 3 flow based on a random-effects model in STEMI patients treated with IC vs. IV administration of tirofiban. (B). Forest plot for TMP grade 3 based on a random-effects model in STEMI patients treated with IC vs. IV administration of tirofiban. (C). Forest plot for in-hospital LVEF based on a random-effects model in STEMI patients treated with IC vs. IV administration of tirofiban. (D). Forest plot for medium-term LVEF based on a random-effects model in STEMI patients treated with IC vs. IV administration of tirofiban. (E). Forest plot for TVR based on a fixed-effects model in STEMI patients treated with IC vs. IV administration of tirofiban. (F). Forest plot for death based on a fixed-effects model in STEMI patients treated with IC vs. IV administration of tirofiban. (G). Forest plot for reinfarction based on a fixed-effects model in STEMI patients treated with IC vs. IV administration of tirofiban. (H). Forest plot for bleeding events based on a fixed-effects model in STEMI patients treated with IC vs. IV administration of tirofiban. (I). Forest plot for MACE based on fixed-effects model in STEMI patients treated with IC vs. IV administration of tirofiban.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4465926&req=5

pone.0129718.g008: Forest plot for endpoints in STEMI patients treated with IC vs. IV administration of tirofiban.(A). Forest plot for TIMI grade 3 flow based on a random-effects model in STEMI patients treated with IC vs. IV administration of tirofiban. (B). Forest plot for TMP grade 3 based on a random-effects model in STEMI patients treated with IC vs. IV administration of tirofiban. (C). Forest plot for in-hospital LVEF based on a random-effects model in STEMI patients treated with IC vs. IV administration of tirofiban. (D). Forest plot for medium-term LVEF based on a random-effects model in STEMI patients treated with IC vs. IV administration of tirofiban. (E). Forest plot for TVR based on a fixed-effects model in STEMI patients treated with IC vs. IV administration of tirofiban. (F). Forest plot for death based on a fixed-effects model in STEMI patients treated with IC vs. IV administration of tirofiban. (G). Forest plot for reinfarction based on a fixed-effects model in STEMI patients treated with IC vs. IV administration of tirofiban. (H). Forest plot for bleeding events based on a fixed-effects model in STEMI patients treated with IC vs. IV administration of tirofiban. (I). Forest plot for MACE based on fixed-effects model in STEMI patients treated with IC vs. IV administration of tirofiban.
Mentions: Sensitivity analyses of the RCTs [29,31–35] were conducted to evaluate the efficacy and safety of IC versus IV tirofiban in patients with ST-elevation myocardial infarction (STEMI) undergoing PCI. However, in the cases with STEMI and PCI, although no significant differences were detected between the effects of an IC or IV tirofiban bolus on complete perfusion after PCI [29,31–35], TMP grade 3 [29,31,33,35], in-hospital LVEF [29,32–34] and medium-term follow-up LVEF [33–35], TVR [31–35], death [29,31,32,34,35], reinfarction [29,31,32,34,35], and bleeding events [29,31,33–35] (P = 0.12, P = 0.16, P = 0.05 and P = 0.61, P = 0.15, P = 0.11, P = 0.51, and P = 0.88, respectively), the pooled data [29,32,34,35] with a fixed-effects model showed that MACE was significantly reduced by IC tirofiban in STEMI patients compared with IV administration (OR 0.48; 95% CI 0.29 to 0.80; P = 0.004, I2 = 36%, heterogeneity P = 0.20). All of the analysis outcomes are detailed in Fig 8. The outcomes regarding MACE based on a random-effects model were also consistent with the above main analyses, and none of the Funnel plot analyses addressing the above outcomes suggested the presence of publication bias.

Bottom Line: Percutaneous coronary intervention (PCI) is known as the most effective treatment for acute coronary syndrome (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.However, there was no statistically significant difference in the risk of bleeding complications between the two groups.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, The first hospital of QinHuangDao, QinHuangDao, HeBei, China.

ABSTRACT

Background: 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.

Methods: 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).

Results: 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.

Conclusions: 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.

No MeSH data available.


Related in: MedlinePlus