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Routine early versus deferred provisional tirofiban treatment in patients with acute coronary syndrome undergoing
You Zhang1, Chuanyu Gao, Hongzhi Liu
1Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, China.
Insights
Early administration of tirofiban in non-ST segment elevated acute coronary syndrome (NSTE-ACS) patients undergoing percutaneous coronary intervention (PCI) improved pre-PCI flow and reduced thrombotic events. However, it did not significantly impact post-PCI outcomes or safety endpoints.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Optimal timing of tirofiban administration in percutaneous coronary intervention (PCI) for non-ST segment elevated acute coronary syndrome (NSTE-ACS) remains under investigation.
- Early administration of tirofiban may improve procedural outcomes by enhancing coronary patency and reducing thrombotic complications.
Purpose of the Study:
- To determine the optimal timing of tirofiban administration in moderate- to high-risk NSTE-ACS patients undergoing PCI.
- To compare the efficacy and safety of routine early tirofiban administration versus deferred provisional administration.
Main Methods:
- Randomized trial comparing routine early tirofiban (≥4h before angiography) versus deferred provisional tirofiban (bailout after angiography) in NSTE-ACS patients undergoing PCI.
- Analysis of creatine kinase MB isoenzyme (CK-MB), Thrombolysis in Myocardial Infarction (TIMI) flow, thrombotic complications, and efficacy/safety endpoints (death, myocardial infarction, target vessel revascularization, bleeding, thrombocytopenia).
Main Results:
- Routine early tirofiban administration resulted in a lower percentage increase in CK-MB and higher pre-PCI TIMI 3 flow compared to the deferred provisional group.
- The routine early group exhibited a significantly lower incidence of thrombotic events during PCI (5.0% vs 33.1%).
- No significant differences were observed in post-PCI TIMI 3 flow, efficacy endpoints, or safety endpoints between the two groups.
Conclusions:
- Early tirofiban administration in moderate- to high-risk NSTE-ACS patients undergoing PCI is associated with improved pre-PCI patency and reduced periprocedural thrombotic complications.
- Early tirofiban administration attenuated minor myocardial damage but did not significantly improve post-PCI TIMI 3 flow or short-term prognosis.
- The study found no significant benefit in efficacy or safety endpoints with routine early tirofiban compared to a deferred provisional strategy.
Abstract:
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.
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