Effects of glycoprotein IIb/IIIa receptor inhibition with tirofiban on minor myocardial damage in angiographically successful percutaneous coronary angioplasty.
OBJECTIVE
The aim of the study was to evaluate the effects of glycoprotein (GP) IIb/IIIa inhibition on minor myocardial injury characterized by cardiac troponin I (cTn-I) and cardiac troponin T (cTn-T) elevation after elective successful percutaneous coronary intervention (PCI).


METHODS
The study consisted of 119 consecutive patients scheduled for elective coronary balloon angioplasty with or without stent implantation. Sixty-three patients (mean age 58 +/- 9.4 years) were randomized to receive standard therapy, including preprocedural aspirin, ticlopidine and intravenous heparin, and 56 patients (mean age 55 +/- 9.6 years) were randomized to additionally receive intravenous tirofiban infusion. cTn-I, cTn-T and CK-MB were measured before and immediately after the procedure, and every 6 h for the first 24 h. A total of 128 stenoses were treated with PCI. Seventy of these lesions were in the standard therapy group and 58 in the tirofiban group.


RESULTS
The frequency of postprocedural abnormal cTn-I levels was significantly higher in the standard therapy group than that in the tirofiban group (37 vs. 16%; p = 0.017). Postprocedural cTn-T elevation occurred in 23% of patients in the standard therapy group and in 8% of patients in the tirofiban group (p = 0.037). The frequencies of CK-MB elevation higher than the upper limit of normal (ULN), and higher than 2 times the ULN were not significantly different between the standard therapy and tirofiban groups (12 vs. 4%, and 7 vs. 2%, respectively).


CONCLUSIONS
GP IIb/IIIa inhibition may reduce the incidence of minor myocardial injury, which may also be a possible mechanism in reducing long-term cardiac events after PCI.
Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey. ertanokmen@hotmail.com
Ertan
E
Okmen
Arda
A
Sanli
Huseyin
H
Uyarel
Sennur
S
Dayi
Zeynep
Z
Tartan
Nese
N
Cam
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D006335:Heart Injuries / Q000097:blood / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D011446:Prospective Studies; D000077466:Tirofiban; D019210:Troponin I / Q000097:blood; D020107:Troponin T / Q000097:blood; D014443:Tyrosine / Q000031:analogs & derivatives* / Q000627:therapeutic use*
D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D019210:Troponin I; D020107:Troponin T; D014443:Tyrosine; D003402:Creatine Kinase; D000077466:Tirofiban