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Routine upstream versus selective down stream use of tirofiban in non-ST elevation myocardial infarction patients

Saman Rasoul1, Jan Paul Ottervanger, Menko Jan de Boer

  • 1Department of Cardiology, Isala Klinieken, Groot Wezenland 20, 8011 JW Zwolle, The Netherlands.

Journal of Thrombosis and Thrombolysis
|March 6, 2007
PubMed

Insights

Routine upstream glycoprotein (GP) IIb/IIIA blocker use in non ST-segment elevation acute coronary syndrome (NSTE ACS) reduced infarct size, especially in male patients with elevated troponin and no clopidogrel pretreatment.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Glycoprotein (GP) IIb/IIIA blockers are underused in non ST-segment elevation acute coronary syndrome (NSTE ACS) despite guidelines.
  • This study compares routine upstream versus selective downstream tirofiban use in NSTE ACS patients.

Purpose of the Study:

  • To compare the efficacy of routine upstream versus selective downstream tirofiban administration in NSTE ACS patients.
  • To evaluate the impact on enzymatic infarct size and initial TIMI flow.

Main Methods:

  • Data from two randomized controlled trials (ELISA-1 and 2) were combined.
  • Inclusion criteria: angina, ST depression >1 mm, and/or positive cardiac biomarkers.
  • Patients underwent coronary angiography; primary endpoint was enzymatic infarct size (LDHQ48).

Main Results:

  • 273 patients received upstream tirofiban, 275 received downstream tirofiban (20% used).
  • Upstream group had more patent culprit lesions (65% vs. 50%) and smaller infarct size (125 vs. 189 IU/l).
  • Upstream tirofiban was effective in males, patients with positive troponin, and those not pretreated with clopidogrel.

Conclusions:

  • Routine upstream GP IIb/IIIa blockers are effective in NSTE ACS patients with elevated troponin and no clopidogrel pretreatment.
  • Further large-scale trials are needed to assess GP IIb/IIIa blockers with clopidogrel pretreatment on major adverse cardiac events.
Abstract

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