Subacute Myocardial Rupture Following Tirofiban Treatment

A 74-year-old male patient was admitted to our emergency department with post-MI angina. On account of the anginal complaint that continued for three days, a coronary artery angiography was undertaken. A percutaneous transluminal coronary angioplasty was performed, followed by the implantation of a coronary stent, and coronary perfusion (TIMI-3) was achieved in the left anterior descending artery. Medical treatment (with acetylsalicylic acid, clopidogrel, metoprolol, atorvastatin and enoxaparine) and tirofiban infusion were duly administered in the coronary care unit. After twenty-four hours, however, acute dyspne, hypotension and tachycardia developed, making it necessary to perform an echocardiography. Since the echocardiography revealed a frank pericardial effusion, the patient was immediately taken to the operation room. The ventricular free wall rupture was repaired with Surgicel, which was prepared in three layers and fixed to the myocardium by tissue glue; cardiopulmonary bypass was not used. To our knowledge, our study constitutes the first case report of a tirofiban-induced free wall rupture.