| Objective:A systematically evaluation of the clinical effectiveness and safety of tirofiban in the prevention of slow/no reflow in patients with acute ST elevation myocardial infarction during percutaneous coronary intervention was conducted.Met hods:The data after April 2021 was retrieved in Cochrane Controlled Trials Database,Pub Med,EMbase,Web of science,Chinese Biomedical Literature Database(CBM),and China National Knowledge Base.Two reviewers independently evaluated the quality of the researches,extracted and cross-checked data.The homogeneous studies were analyzed by Meta-analysis using Rev Man 5.2 software.Results:A total of 16 studies were introduced,including 4336 patients.The Meta-analysis results showed that preoperative administration of tirofiban in patients with acute ST-segment elevation myocardial infarction can significantly improve coronary TIMI blood flow(OR=0.63,95%CI(0.40,0.99),P=0.05),while there was no significant difference in corrected TIMI frame count(CTFC)(WMD=-1.76,95%CI(-6.94,3.42),P=0.51)and in myocardial Blush classification(OR=0.98,95%CI(0.75,1.28),P=0.87).Tirofiban can significantly reduce the incidence of major adverse cardiac events during hospitalization(OR=0.37,95%CI(0.22,0.64),P=0.0003)and 1 month after surgery(OR=0.57,95 %CI(0.43,0.76),P=0.0001),and significantly improved the postoperative ST segment fall rate(OR=1.33,95%CI(1.04,1.70),P=0.02).In the subgroup analysis,there was no statistically significant difference in the incidence of adverse(OR=1.20,95%CI(0.56,2.56),P=0.64)and bleeding(OR=0.92,95%CI(0.73,1.17),P=0.51)events between the standard-dose(10 μg/kg)and loading-dose groups of tirofiban(25 μg/kg).The incidence of adverse events in the long-term group of intravenous tirofiban(>24 h: including 36 h,48 h)was lower than that of the short-term group(≤24 h: including 12 h,18 h,24 h)(OR=2.89,95 %CI(1.33,6.32),P=0.008).However,there was no significant difference in the incidence of bleeding events between the short-term group and the long-term group(OR=0.71,95%CI(0.31,1.65),P=0.43).Conclusion:The administration of tirofiban during percutaneous coronary intervention can improve coronary TIMI blood flow in patients with acute ST-segment elevation myocardial infarction,and prevent slow/no reflow.The administration of tirofiban during percutaneous coronary intervention can improve coronary TIMI blood flow in patients with acute ST-segment elevation myocardial infarction,and prevent slow/no reflow. |
