Adjunctive Tirofiban is not Associated with Reduced 30-Day Ischemic Events in NSTE-ACS Patients with Complex Coronary...

Glycoprotein IIb/IIIa inhibitors are generally reserved for selected high-thrombotic-risk or bailout percutaneous coronary intervention (PCI) scenarios, but their routine value in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients with anatomically complex coronary lesions remains uncertain. We evaluated adjunctive tirofiban in patients with left main, chronic total occlusion, bifurcation, ostial, long, or severely calcified lesions, while excluding confirmed intracoronary thrombus, no-reflow, or slow-flow.

This retrospective observational study included 1462 NSTE-ACS patients undergoing PCI with stent implantation. Patients receiving dual antiplatelet therapy (DAPT) with or without tirofiban were compared. The efficacy endpoint was 30-day composite ischemic events, and the safety endpoint was any bleeding. Multivariable adjustment and 1:1 propensity score matching (PSM) were performed.

In the overall cohort, tirofiban was not associated with lower ischemic risk (9.35% vs 9.42%; unadjusted OR 0.99, 95% CI 0.68-1.45; adjusted OR 1.02, 95% CI 0.68-1.52). Bleeding was numerically higher but not significant (3.94% vs 3.59%; adjusted OR 1.08, 95% CI 0.58-2.01). After matching, 431 patients per group were retained. Ischemic events (10.21% vs 9.51%; OR 1.08, 95% CI 0.69-1.69) and bleeding events (5.10% vs 3.71%; OR 1.40, 95% CI 0.72-2.69) remained non-significantly higher with tirofiban. No significant subgroup interactions were observed.

In this selected non-thrombotic complex-lesion NSTE-ACS cohort, routine adjunctive tirofiban was not associated with improved 30-day ischemic outcomes. Anatomical complexity alone may be insufficient to justify routine "add-on" tirofiban in the absence of thrombotic or bailout indications.