AIM To analyze the effect of intracoronary administration combined with intravenous infusion of low-dose tirofiban on hospitalization outcomes in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI).

METHODS Patients with STEMI who underwent PPCI (n=748) from September 2016 to December 2022 were enrolled and divided into the tirofiban group (observation group, n=284) and the non-tirofiban group (control group, n=464) based on the use of tirofiban. Inverse probability weighting and 1:1 greedy matching were applied to balance the baseline covariates of the two groups and compare their mortality rates. Logistic regression analysis was used to analyze the effect of intracoronary administration combined with intravenous infusion of tirofiban on hospitalization outcomes.

RESULTS Compared with the control group before weighting, the observation group had a higher propensity score (P<0.01), a lower proportion of hyperlipidemia history (P<0.01), a higher proportion of peripheral arterial disease history (P<0.05), and a higher proportion of statin, beta blocker, ACEI, and ARB use (all P<0.01). After inverse probability weighting, the baseline characteristics of the two groups of patients reached inter group balance. Compared with the control group before weighted intervention data and survival outcomes, the observation group had a higher propensity score (P<0.01), a higher proportion of LAD culprit vessel (P<0.05), a lower proportion of LCX culprit vessel (P<0.05), a higher proportion of IABP (P<0.01), a higher proportion of TIMI blood flow<grade 3 (P<0.01), and a higher proportion of ventricular tachycardia and ventricular fibrillation (all P<0.05). During hospitalization, 19 patients (6.7%) in the observation group died, while 14 patients (3.0%) in the control group died. Before inverse probability weighting, logistic regression analysis showed that tirofiban increased the risk of in-hospital mortality (OR=2.305, 95% CI: 1.137~4.673, P<0.05); After inverse probability weighting, logistic regression analysis showed that tirofiban had no significant effect on hospitalization outcomes (OR=1.438, 95% CI: 0.653~3.168). After greedy matching, logistic regression analysis also showed that the use of tirofiban had no significant effect on hospitalization outcomes (OR=1.265, 95% CI: 0.412~3.888), consistent with the results of inverse probability weighted analysis.

CONCLUSION Intracoronary administration combined with intravenous infusion of low-dose tirofiban in patients with acute STEMI undergoing PPCI has no significant effect on hospitalization outcomes.