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GPIIb/IIIa Receptor Antagonism Using Small Molecules Provides no Additive Long-Term Protection after Percutaneous
Michele Schiariti1, Angela Saladini, Francesco Papalia
1S. Anna Hospital, Catanzaro University "La Sapienza", Rome, Italy.
Insights
Adding small molecules like tirofiban or eptifibatide to dual antiplatelet therapy (DAPT) did not reduce ischemic events after percutaneous coronary intervention (PCI). Thrombolysis with tenecteplase showed a protective effect in this patient group.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Controversy exists regarding the efficacy of small anti-aggregating drugs (AADs) like tirofiban and eptifibatide in reducing ischemic events post-percutaneous coronary intervention (PCI).
- Real-world clinical data is needed to clarify the benefits of these agents in patients undergoing PCI.
Purpose of the Study:
- To compare the incidence of composite ischemic events within one year in patients undergoing PCI.
- To evaluate the effectiveness of adding small molecules (tirofiban or eptifibatide) to dual anti-aggregating drugs (AAD) compared to standard DAPT.
Main Methods:
- A comparative study of consecutive patients undergoing PCI.
- Group 1: Oral double AAD (clopidogrel and aspirin). Group 2: Single AAD plus tirofiban or eptifibatide prior to PCI.
- Primary endpoint: Composite ischemic events within one year, analyzed using Cox regression.
Main Results:
- No significant difference in composite ischemic events between the double AAD alone group (11.6%) and the double AAD plus small molecules group (9.8%).
- Significant risk factors for events included age, diabetes, and intra-aortic balloon pump use.
- Thrombolysis with tenecteplase and hypertension were significant protective factors.
Conclusions:
- In patients undergoing PCI on dual antiplatelet therapy (clopidogrel plus aspirin), small molecules (tirofiban or eptifibatide) did not provide additional long-term protection against composite ischemic events.
- Thrombolysis with tenecteplase demonstrated a protective effect in this clinical setting.
Background:
There is some controversy as to whether tirofiban or eptifibatide, two small anti-aggregating drugs (AAD), may reduce the incidence of composite ischemic events within one year in patients undergoing percutaneous coronary intervention (PCI) in the real clinical world.
Methods:
We compared consecutive patients on oral double AAD (with clopidogrel and aspirin) who underwent PCI (n=207) and patients who were on single AAD and received a second AAD, just prior to PCI, and either high-dose tirofiban or double-bolus eptifibatide (double AAD plus small molecules group, n=666). The primary end point (incidence of composite ischemic events within one year) included death, acute myocardial infarction, unstable angina, stent thrombosis or repeat PCI or coronary bypass surgery (related to the target vessel PCI failure) and was modelled by Cox's regression.
Results:
There were 89 composite ischemic events: 24 (11.6%) in double AAD alone and 65 (9.8%) in double AAD plus small molecules groups (log-rank test: p=0.36). Incidences by type of ischemic events were similar between the 2 groups. Based on 21 potential covariates fitted simultaneously, adjusted hazard ratios (HR and 95% confidence intervals) showed that age (HR 1.03, 1.01-1.06, p=0.01), diabetes (HR 1.68, 1.01-2.79, p=0.05) and intra aortic balloon pump (HR 5.12, 2.36-11.10, p=0.0001) were significant risk factors whereas thrombolysis by tenecteplase (HR 0.35, 0.13-0.98, p=0.05) and having had hypertension or anti-hypertensive treatment (HR 0.58, 0.36-0.93, p=0.03) were significant protectors for events. Whether small molecules were present provided a non significant additional benefit as compared to double AAD alone (HR 0.83, 0.51-1.36, p=0.46). Pre-PCI CK-MB were not useful to predict events (HR 1.01, 0.99-1.01, p=0.17).
Conclusions:
In clinical world patients undergoing PCI (rescue plus primary <13%) while on double AAD, based on clopidogrel plus aspirin, small molecules (tirofiban or eptifibatide) provided no additive long-term protection against the occurrence of composite ischemic events whereas thrombolysis by tenecteplase did.
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