Efficacy of IRA targeted administration of low-dose tenecteplase combined with tirofiban in high thrombotic burden STEMI patients undergoing emergency PCI

AIM  To evaluate the clinical efficacy of infarct-related artery (IRA) targeted administration of low-dose tenecteplase (TNK-tPA) combined with tirofiban during emergency percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI) and high thrombotic burden.

METHODS  A total of 120 acute STEMI patients undergoing emergency PCI between April 2023 and February 2024 were randomly divided into two groups: a control group (60 cases, TNK-tPA alone) and an observation group (60 cases, TNK-tPA + tirofiban). Postoperative outcomes, including TIMI flow grade, TIMI myocardial perfusion grade (TMPG), myocardial necrosis markers serum creatine kinase (CK), creatine kinase isoenzyme (CK-MB), lactate dehydrogenase (LDH), myocardial reperfusion injury markers serum endothelin (ET), high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), and early cardiac function indicators plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) and left ventricular ejection fraction (LVEF), were compared between the two groups.

RESULTS  Compared with the control group, the observation group had a significantly higher proportion of grade 3 in TIMI blood flow grading immediately after surgery (P<0.05), and a significantly higher proportion of grade 3 in TMPG immediately after PCI compared to the control group (P<0.05); After PCI, the peak concentrations of CK (P<0.01), CK-MB (P<0.05), LDH (P<0.05), TNF-α (P<0.01), ET-1 (P<0.01), and hs CRP (P<0.01) in the observation group were lower than those in the control group. There was no statistically significant difference in plasma NT proBNP concentration and LVEF values between the two groups of patients 24 hours after surgery. Follow up was conducted one month after surgery, and the LVEF values in the observation group were higher than those in the control group (P<0.01) and also higher than those in the same group 24 hours after surgery (P<0.01); The concentration of NT proBNP was lower than that of the control group (P<0.01) and also lower than that of the same group at 24 hours after surgery (P<0.01); The comparison of bleeding incidence between the two groups showed that there were 3 cases (5.00%) of bleeding in the observation group and 4 cases (6.67%) in the control group, with no statistically significant difference between the two groups.

CONCLUSION  IRA targeted administration of low-dose TNK-tPA combined with tirofiban during emergency PCI effectively restores coronary blood flow, improves myocardial perfusion, reduces myocardial injury, and promotes cardiac functional recovery in high thrombotic burden STEMI patients, demonstrating favorable clinical outcomes without increasing bleeding risk.