1. Muhammad Nawaz Lashari 2. Muhammad Tanveer Alam 3. Tariq Ashraf 

4. Mukhtiar Ahmad Pathan 

1. Asstt. Prof. of Cardiology, DUHS&CH, Karachi 2. Asstt. Prof. of Medicine, DUHS&CH, Karachi

3. Asstt. Prof. of Cardiology, NICVD, Karachi 4. Senior Medical Officer, DUH Ojha Complex, Karachi

ABSTRACT

Objective: Currently in acute coronary syndrome, PCI is most common strategy. No-reflow phenomenon (NR) is one of serious complication. Aim of this study was to evaluate role of intracoronary bolus administration of tirofiban in acute coronary syndrome patients with no-reflow during PCI.

Study Design: It is prospective and observational study.

Place and Duration of Study: It is multicenter study, conducted in Karachi, Pakistan from August 2011 to  July 2013.

Patients and Methods: Total of 62 patients of acute coronary syndrome underwent for PCI and developed noreflow, received intracoronary bolus tirofiban were included. The angiographic definition of successful reperfusion should include both  TIMI 3 flow as well as MBG 2 or 3. No-reflow,   assesed by thrombolysis in myocardial infarction (TIMI) flow and myocardial blush grade (MBG) during treatment. Data were entered and analyzed using SPSS-16 software. Statistical significance was defined as p-value <0.05.

Results: Out of 62 patients, 43 were males .The mean age was 51 ±13, range from 37 to 70 years. TIMI flow 1 and 11 seen in 17, 37 patients while MBG 1 and 11 seen in 20 and 33 patients before intracoronary bolus administration of tirofiban. After bolus administration of tirofiban, TIMI flow 111 was seen in 61(98.387 %) out of 62 patients while MBG 11 and 111 was also noted in 61(98.387 %) out of 62 patients. It showed better Thrombolysis In Myocardial Infarction flow grades and TIMI myocardial perfusion grades (OR 0. 22, 95% CI 0 .12 -0 .39, p-value <0.001) immediately after intracoronary bolus administration of tirofiban in reflow phenomenon patients  during PCI.

Conclusion: In patients with ACS, Intracoronary bolus adminstration of tirofiban is effective drug to improve noreflow during percutaneous coronary intervention especially when patient blood pressure is at lower-side.

Key Words: Intracoronary, bolus tirofiban,   Acute coronary syndrome,  No-reflow, PCI.