patients with acute myocardial infarction, who were transferred to a PCI centre, were randomised to early, pre-hospital initiation of Tirofiban (Early) or to initiation in the catheterisation laboratory (Late). The primary end-point was TIMI flow grade 3 of the infarct-related vessel (IRV) at initial angiography, as assessed by an independent core-lab. The effect of Tirofiban on each TIMI flow component, the presence of thrombus at initial angiography and pre-PCI myocardial blush grade were

more »

... ndary end-points. A large proportion of patients (41%) was diagnosed and randomised in the ambulance, without intervention of a physician. In the Early group, Tirofiban was administered a median of 59 min (range 11-178 min) earlier than in the Late group. At initial angiography, TIMI 3 flow was present in 19% the Early group and in 15% in the Late group (P ¼ 0:22). The combined incidence of TIMI 2 or 3 flow was present in 43% in the Early group and in 34% in the Late group, respectively (P ¼ 0:04). Thrombus or a fresh occlusion was present in 60% and 73% in the Early and Late group, respectively (P ¼ 0:002). A pre-PCI myocardial blush grades 2 or 3 was more often present in the Early group (30% vs. 22%, P ¼ 0:04). However, no difference in TIMI 3 flow or myocardial blush grade was found between the groups, post-PCI. At one-year followup, the combined incidence of death or recurrent MI was not different between the groups (7.0% vs. 7.0%, P ¼ 0:99). Conclusion Early initiation of Tirofiban did not improve initial TIMI 3 flow of the IRV significantly. Despite a better patency (TIMI 2 or 3 flow), a lower prevalence of thrombus or fresh occlusion and a better myocardial perfusion in the infarct-related region pre-PCI, no beneficial effect on post-PCI angiographic or clinical outcome was found, as compared to initiation of Tirofiban in the catheterisation laboratory.