Effects of adjunctive tirofiban during PCI on myocardial perfusion and ventricular function in myocardial infarction: a 3D echocardiography-based evaluation

Objective This study aimed to evaluate the effects of adjunctive tirofiban during PCI on myocardial perfusion and ventricular functional recovery in patients with myocardial infarction using angiographic myocardial blush grade (MBG) and three-dimensional echocardiography (3DE). Methods A retrospective review identified 114 eligible patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary PCI at our hospital from March 2024 to May 2025, including 61 patients who received PCI alone and 53 who received PCI with adjunctive tirofiban. After 1:1 propensity score matching (PSM), 48 matched pairs (96 patients) were included in the final analysis. Myocardial perfusion was assessed using angiographic myocardial blush grade (MBG), whereas left ventricular ejection fraction (LVEF) was quantified from three-dimensional echocardiographic full-volume datasets using offline TomTec analysis. Major adverse cardiac events (MACE) were recorded during a 90-day follow-up after PCI and included cardiac death, recurrent myocardial infarction, hospitalization for worsening heart failure, and unplanned target-vessel revascularization. Results The general baseline data of the two groups showed no statistically significant difference, indicating comparability ( P > 0.05). Baseline MBG, LVEF, cTnI, SOD, and ET levels were also comparable between the two groups (all P > 0.05). Both groups showed significant changes from baseline after treatment, with greater improvements in these indicators observed in the treatment group (all P < 0.001 for between-group comparisons of changes). The myocardial blush grade (MBG) and left ventricular ejection fraction (LVEF) were significantly higher in the treatment group than in the control group (2.42 ± 1.02 vs. 1.58 ± 0.88 and 55.74 ± 3.12 vs. 48.89 ± 5.17, respectively; both P < 0.001). The cardiac troponin I (cTnI) level was significantly lower in the treatment group than in the control group (12.34 ± 1.76 vs. 16.73 ± 1.98, P < 0.001). The treatment group also showed a significantly higher superoxide dismutase (SOD) level (100.89 ± 3.21 vs. 90.11 ± 2.86, P < 0.001) and a significantly lower endothelin (ET) level (58.42 ± 1.65 vs. 77.24 ± 1.83, P < 0.001). During the 90-day follow-up, the incidence of MACE was significantly lower in the treatment group than in the control group (6/48, 12.50% vs. 17/48, 35.42%; P = 0.009). Conclusion Adjunctive tirofiban during PCI was associated with greater improvements in myocardial perfusion and ventricular functional recovery than PCI alone. Three-dimensional echocardiography provided quantitative assessment of ventricular functional changes, while angiographic MBG provided complementary information on myocardial tissue perfusion. Given the single-center retrospective design, these findings should be interpreted cautiously and require confirmation in larger prospective studies.