title: Routine early versus deferred provisional tirofiban treatment in patients with acute coronary syndrome undergoing percutaneous coronary intervention.
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.
authors.affiliation: Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, China.
authors.forename: You
authors.initials: Y
authors.lastname: Zhang
authors.forename: Chuanyu
authors.initials: C
authors.lastname: Gao
authors.forename: Hongzhi
authors.initials: H
authors.lastname: Liu
authors.forename: Xianpei
authors.initials: X
authors.lastname: Wang
authors.forename: Honghui
authors.initials: H
authors.lastname: Yang
authors.forename: Muwei
authors.initials: M
authors.lastname: Li
authors.forename: Xianqing
authors.initials: X
authors.lastname: Wang
authors.forename: Zhongyu
authors.initials: Z
authors.lastname: Zhu
authors.forename: Dayi
authors.initials: D
authors.lastname: Hu
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000453:epidemiology / Q000601:surgery*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003131:Combined Modality Therapy; D004334:Drug Administration Schedule; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011183:Postoperative Complications / Q000453:epidemiology; D013921:Thrombocytopenia / Q000453:epidemiology; D000077466:Tirofiban; D016896:Treatment Outcome; D014443:Tyrosine / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D005343:Fibrinolytic Agents; D014443:Tyrosine; D000077466:Tirofiban