Application Of Tirofiban In The Treatment Of Acute ST Elevation Myocardial Infarction During Primary Percutaneous Coronary Intervention: A Meta-analysis

Objective: To assess the efficacy and safety of platelet GPâ…¡b/â…¢a antagonist tirofiban in acute ST-segment elevation myocardial infarction (STEMI) patients with primary percutaneous coronary intervention (PCI).Methods: PubMed, highwire, ProQuest, OVID, english medical current contents, Chinese Biomedical Database, Chinese Conference data and vip database were searched up to 2009. Randomized controlled trials comparing the efficacy and safety with tirofiban in STEMI patients with primary PCI were enrolled. Two researchers collected the data independently. Methodological quality of trials was assessed in terms of generation of allocation sequence, blinding, and drop-outs. The data was quantified by meta-analysis.Results: 20 Randomized controlled trials, which enrolled a total of 1658 patients, were included in the analysis. (851 in the treatment group and 807 in the control group). The methodological quality was generally low. Overall, compared with the control group, tirofiban significantly increased Thrombolysis In Myocardial Infarction (TIMI) grade 3 flow rate (risk ratio [RR]= 1.13; 95% confidence interval [CI] [1.08, 1.18]; P<0.00001) and left ventricular ejection fraction (LVEF) (weighted mean difference [WMD]=6.10%, 95%CI[3.73%, 8.47%], P<0.00001), decreased corrected TIMI frame count(CTFC) (WMD =-7.86 frame, 95%CI[-9.52 frame, -6.20 frame], P<0.00001) and the rate of major primary end point(MACE) (RR=0.27, 95%CI [0.19, 0.36], P<0.00001), however, the rate of hemorrhage was significantly increased(RR=1.80, 95%CI [1.30, 2.50], P=0.0004).Conclusion: In STEMI patients with primary PCI, Tirofiban improves coronary flow, LVEF, and clinical outcomes, however, increases the rate of hemorrhage. Therefore, more attention should be taken in clinical work.