Randomised controlled trial evaluating the role of tirofiban in high-risk non-ST elevation acute coronary syndromes: an East Indian perspective.
BACKGROUND
Glycoprotein IIb/IIIa inhibitors such as tirofiban inhibit platelet aggregation. We evaluated the immediate and early outcomes in patients with high-risk non-ST elevation acute coronary syndrome (NSTE ACS) who received tirofiban with conventional therapy compared to patients who received only conventional therapy (a combination of aspirin, clopidogrel, low-molecular-weight heparin with or without beta-blockers and angiotensin-converting enzyme inhibitors).


METHODS
A total of 165 patients received conventional therapy with a placebo, and 136 patients received conventional therapy with tirofiban after randomisation. The outcomes were measured on Day 7, Day 14, one month and three months after the administration of therapy.


RESULTS
A significant reduction was noted in the occurrence of primary endpoints in patients receiving tirofiban, compared to those who received a placebo at seven days (14 versus 32; p-value is 0.036), 14 days (14 versus 28; p-value is 0.043), one month (19 versus 34; p-value is 0.01) and three months (30 versus 44; p-value is less than 0.001) after administration. There was a significant reduction in the occurrence of fatal myocardial infarction (MI) (1 versus 8; p-value is 0.044) and non-fatal MI at Day 7 (1 versus 8; p-value is 0.044), and refractory ischaemia at the end of one month (14 versus 24; p-value is 0.04) and three months (25 versus 36; p-value is less than 0.01) in patients receiving tirofiban as compared to those receiving a placebo.


CONCLUSIONS
It may be concluded that tirofiban has a definite role in improving the outcome of patients with high-risk NSTE ACS.
Bhattacharya
R
R
Department of Cardiology, Medical College Kolkata, 88 College Street, Kolkata 700073, West Bengal, India.
Pani
A
A
Dutta
D
D
Basak
S
S
Gangopadhyay
S
S
Das Baksi
S
S
Sarkar
R N
RN
D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D000368:Aged; D001241:Aspirin / Q000008:administration & dosage; D000077144:Clopidogrel; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D017984:Enoxaparin / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007194:India; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D012016:Reference Values; D012720:Severity of Illness Index; D015996:Survival Rate; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000077466:Tirofiban; D016896:Treatment Outcome; D014443:Tyrosine / Q000008:administration & dosage / Q000031:analogs & derivatives*
D017984:Enoxaparin; D010975:Platelet Aggregation Inhibitors; D014443:Tyrosine; D000077144:Clopidogrel; D000077466:Tirofiban; D013988:Ticlopidine; D001241:Aspirin