Short-Term Clinical Outcome of Intracoronary Bolus versus Standard Intravenous Administration of Tirofiban during Primary Percutaneous Coronary Intervention in Patients with St-Elevation Myocardial Infarction

Background: Intracoronary (IC) tirofiban might confer therapeutic benefits by delivering higher local drug concentrations at the culprit lesion, potentially enhancing platelet inhibition and thrombus resolution. Objective: This study aimed to compare the short-term safety and efficacy of IC bolus-only strategy with the standard intravenous (IV) bolus succeeded by infusion in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI). Methods: 146 STEMI patients undergoing PCI were enrolled, divided equally into two groups: One receiving standard intravenous tirofiban and the other a single IC bolus. Efficacy and safety outcomes were evaluated during hospitalization and at 30 days. Results: Left ventricular ejection fraction (LVEF) at discharge was comparable among the IV and IC groups (47.9% vs. 47.4%, p=0.668). TIMI 3 flow was achieved in 64.4% and 71.2% of the IV and IC groups respectively without significant differences in post-PCI flow grades (p=0.667). The composite 30-days major adverse cardiovascular events (MACE) rate was lower in the IC group (20.5% vs. 28.8%), though not statistically significant (p=0.249). A trend toward fewer stent thrombosis events was observed with IC bolus therapy. The most notable benefit of IC administration was its superior safety profile, reflected by markedly lower rates of BARC type 1 bleeding (2.7% vs. 49.3%, p<0.001), BARC type 2 bleeding (4.1% vs. 21.9%, p=0.001), and vascular complications (5.5% vs. 35.6%, p<0.001). Major bleeding was rare in both groups. Conclusion: In STEMI patients undergoing primary PCI, IC bolus-only tirofiban provided comparable short-term efficacy to standard IV infusion, while markedly reduced bleeding and vascular complications.