title: Effects of tirofiban plus clopidogrel versus clopidogrel plus provisional abciximab on biomarkers of myocardial necrosis in patients with non-ST-elevation acute coronary syndromes treated with early aggressive approach. Results of the CLOpidogrel, upstream TIrofiban, in cath Lab Downstream Abciximab (CLOTILDA) study.
abstract: BACKGROUND
  In non-ST-elevation acute coronary syndromes (NSTE-ACS), a strong correlation between adverse clinical events and peak values of myocardial necrosis markers has been found. In this study, we evaluated whether the adjunctive treatment with upstream tirofiban reduces the peak levels of cardiac troponin I and creatine kinase-MB (CK-MB) fraction in patients with NSTE-ACS undergoing early invasive strategy and pretreated with aspirin, heparin, and clopidogrel.
  
  
  METHODS
  A total of 300 patients were randomized to receive tirofiban (group 1) or not (group 2). Serial marker samples were collected before and after coronary angiography in all cases and after percutaneous coronary intervention (PCI) when performed.
  
  
  RESULTS
  Between the 2 groups, no differences were observed in clinical and angiographic findings. Percutaneous coronary intervention was globally performed in 198 patients (66%). Of 99 group 2 patients, 26 (26%) received abciximab just before PCI. No significant differences between the 2 groups were observed with regard to cardiac troponin I and CK-MB values at admission and at 6, 12, and 24 hours thereafter; peak values before coronary angiography; and peak values of index event. In addition, the cumulative biomarkers release of the index event was similar between the 2 groups. Major bleeding rate was 2% in group 1 and 1% in group 2 (P = not significant). Composite incidence of death, myocardial infarction, or rehospitalization for ACS at 30 days was 9% in group 1 and 10% in group 2.
  
  
  CONCLUSIONS
  In patients with NSTE-ACS undergoing early invasive strategy, the adjunctive administration of upstream tirofiban did not reduce the peak values and the cumulative release of myocardial necrosis markers, compared with aspirin, heparin, and clopidogrel given on admission and associated with selective use of abciximab just before PCI.
authors.affiliation: Division of Cardiology, Misericordia e Dolce Hospital, Prato, Italy. leoncini.mario@tiscali.it
authors.forename: Mario
authors.initials: M
authors.lastname: Leoncini
authors.forename: Anna
authors.initials: A
authors.lastname: Toso
authors.forename: Mauro
authors.initials: M
authors.lastname: Maioli
authors.forename: Francesco
authors.initials: F
authors.lastname: Bellandi
authors.forename: Toni
authors.initials: T
authors.lastname: Badia
authors.forename: Alessandro
authors.initials: A
authors.lastname: Politi
authors.forename: Stefano
authors.initials: S
authors.lastname: De Servi
authors.forename: Roberto Piero
authors.initials: RP
authors.lastname: Dabizzi
mesh_terms: D000077284:Abciximab; D000208:Acute Disease; D000368:Aged; D000789:Angina, Unstable / Q000097:blood / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D000077144:Clopidogrel; D052279:Creatine Kinase, MB Form / Q000097:blood; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use*; D008297:Male; D009203:Myocardial Infarction / Q000097:blood* / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology; D009336:Necrosis; D011446:Prospective Studies; D013577:Syndrome; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013997:Time Factors; D000077466:Tirofiban; D019210:Troponin I / Q000097:blood; D014443:Tyrosine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D019210:Troponin I; D014443:Tyrosine; D000077144:Clopidogrel; D052279:Creatine Kinase, MB Form; D000077466:Tirofiban; D013988:Ticlopidine; D000077284:Abciximab