Efficacy and safety of intracoronary high-dose bolus-only tirofiban in STEMI patients undergoing primary PCI

Background: ST-elevation myocardial infarction (STEMI) is a life-threatening cardiac emergency that needs to be treated with primary percutaneous coronary intervention (PCI). Thrombus burden, however, during PCI can cause impaired myocardial perfusion and complications in the PCI procedure. Intracoronary high-dose bolus of Tirofiban, a glycoprotein IIb/IIIa inhibitor, can be useful to improve coronary flow. Objective: o compares the efficacy and safety of intracoronary bolus tirofiban (high dose bolus only) in STEMI patients undergoing primary PCI. Methods: This descriptive study was conducted in Department of Cardiology, Armed forces Institute of Cardiology/National Institute of Heart Diseases Rawalpindi from October 2025 to January 2026, including 288 STEMI patients who received primary PCI. The sample size was calculated according to WHO sample size formula. Patients who were eligible received intracoronary high dose bolus-only tirofiban during PCI. Efficacy was evaluated by post procedure TIMI flow grade, myocardial blush grade and ST segment resolution. Bleeding complications, thrombocytopenia, reinfarction and in-hospital mortality were assessed as indications of safety. Results: Intracoronary tirofiban was shown to improve post procedural coronary flow and to obtain a satisfactory myocardial blood flow in most patients. The reperfusion was effective in a large proportion of patients, with the ST-segment resolution seen. The incidence of major bleeding and severe thrombocytopenia was scarce. Conclusion: High dose bolus-only tirofiban may be an effective and safe adjunctive therapy for STEMI patients undergoing PCI, with good outcomes in the reperfusion phase and reasonable bleeding risk.