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(Circulation. 2003;107:1497.)
© 2003 American Heart Association, Inc.

Clinical Investigation and Reports

Adjunctive Platelet Glycoprotein IIb/IIIa Receptor Inhibition With Tirofiban Before Primary Angioplasty Improves Angiographic Outcomes

Results of the TIrofiban Given in the Emergency Room before Primary Angioplasty (TIGER-PA) Pilot Trial

David P. Lee, MD; Niall A. Herity, MD; Bonnie L. Hiatt, MD; William F. Fearon, MD; Mehrdad Rezaee, MD; Andrew J. Carter, DO; Michelle Huston, MD; Donald Schreiber, MD; Peter M. DiBattiste, MD; Alan C. Yeung, MD

From Stanford University Medical Center, Divisions of Cardiovascular Medicine (D.P.L., N.A.H., B.L.H., W.F.F., M.R., A.J.C., A.C.Y.) and Emergency Medicine (M.H., D.S.), Stanford, Calif, and Merck Research Laboratories (P.M.D.), Blue Bell, Pa.

Correspondence to Dr David P. Lee, Stanford University Medical Center, Interventional Cardiology, Room H-2103, 300 Pasteur Dr, Stanford, CA 94305. E-mail dplee{at}stanford.edu

Background— Previous work has suggested that platelet glycoprotein IIb/IIIa receptor blockade may confer benefit in the treatment of acute myocardial infarction. The TIGER-PA pilot trial was a single-center randomized study to evaluate the safety, feasibility, and utility of early tirofiban administration before planned primary angioplasty in patients presenting with acute myocardial infarction.

Methods and Results— A total of 100 patients presenting with acute myocardial infarction were randomized to either early administration of tirofiban in the emergency room or later administration in the catheterization laboratory. The primary outcome measures were initial TIMI grade flow, corrected TIMI frame counts, and TIMI grade myocardial perfusion ("blush"). Thirty-day major adverse cardiac events were also assessed. Angiographic outcomes demonstrate a significant improvement in initial TIMI grade flow, corrected TIMI frame counts, and TIMI grade myocardial perfusion when patients are given tirofiban in the emergency room before primary angioplasty. The rate of 30-day major adverse cardiac events suggests that early administration may be beneficial.

Conclusions— This pilot study suggests that early administration of tirofiban improves angiographic outcomes and is safe and feasible in patients undergoing primary angioplasty for acute myocardial infarction.

Key Words: myocardial infarction • angioplasty • platelets