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Routine early versus deferred provisional tirofiban treatment in patients with acute coronary syndrome undergoing percutaneous coronary intervention
Author(s) -
Zhang You,
Gao Chuanyu,
Liu Hongzhi,
Wang Xianpei,
Yang Honghui,
Li Muwei,
Wang Xianqing,
Zhu Zhongyu,
Hu Dayi
Publication year - 2013
Publication title -
clinical and experimental pharmacology and physiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 103
eISSN - 1440-1681
pISSN - 0305-1870
DOI - 10.1111/1440-1681.12065
Subject(s) - tirofiban , medicine , timi , conventional pci , percutaneous coronary intervention , myocardial infarction , cardiology , thrombolysis , acute coronary syndrome , revascularization
Summary The present study examined the optimal timing of tirofiban administration in moderate‐ or high‐risk non‐ ST segment elevated acute coronary syndrome ( NSTE ‐ ACS ) patients undergoing percutaneous coronary intervention ( PCI ). Eligible patients were randomized into two groups. Tirofiban was administered routinely at ≥ 4 h before angiography (routine early group; n = 141 patients) or provisionally only for bailout after angiography (deferred provisional group; n = 145 patients). The parameters analysed were: creatine kinase MB isoenzyme ( CK ‐ MB ), thrombolysis in myocardial infarction ( TIMI ) flow, thrombotic complications during PCI , efficacy end‐points (death, myocardial infarction or target vessel revascularization) at 7, 30 and 180 days and safety end‐points (bleeding or thrombocytopenia). In the deferred provisional group, 48 patients (33.1%) required bailout tirofiban. Tirofiban was administered 5.8 h earlier in the routine early compared with the deferred provisional group. The routine early group showed a lower percentage increase in CK ‐ MB (in U/L) 12–24 h after PCI compared with the deferred provisional group (0 (−4.0, 3.0) vs 0.4 (−3.0, 5.0), respectively; P = 0.045), as well as higher pre‐ PCI TIMI 3 (i.e. normal) flow (78.7% vs 64.8%, respectively; P = 0.042) and a lower incidence of thrombotic events (5.0% vs 33.1%, respectively; P < 0.0001). There were no significant differences in efficacy and safety end‐points. In patients with moderate‐ or high‐risk NSTE ‐ ACS , early tirofiban combined with dual antiplatelet therapy was associated with better patency before PCI , attenuated minor myocardial damage and a lower prevalence of thrombotic complications during PCI , but had no significant benefit on the post‐ PCI TIMI 3 flow or short‐term prognosis.