Routine early versus deferred provisional tirofiban treatment in patients with acute coronary syndrome undergoing percutaneous coronary intervention

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.