title: Efficacy and safety of tirofiban-supported primary percutaneous coronary intervention in patients pretreated with 600 mg clopidogrel: results of propensity analysis using the Clinical Center of Serbia STEMI Register.
abstract: BACKGROUND
  Studies with platelet glycoprotein IIb/IIIa receptor inhibitors (GPIs) showed conflicting results in primary percutaneous coronary intervention (PPCI) patients who were pretreated with 600 mg clopidogrel. We sought to investigate the short- and long-term efficacy and safety of the periprocedural administration of tirofiban in a largest Serbian PPCI centre.
  
  
  METHODS
  We analysed 2995 consecutive PPCI patients enrolled in the Clinical Center of Serbia STEMI Register, between February 2007 and March 2012. All patients were pretreated with 600 mg clopidogrel and 300 mg aspirin. Major adverse cardiovascular events, comprising all-cause death, nonfatal infarction, nonfatal stroke, and ischaemia-driven target vessel revascularization, was the primary efficacy end point. TIMI major bleeding was the key safety end point.
  
  
  RESULTS
  Analyses drawn from the propensity-matched sample showed improved primary efficacy end point in the tirofiban group at 30-day (OR 0.72, 95% CI 0.53-0.97) and at 1-year (OR 0.74, 95% CI 0.57-0.96) follow up. Moreover, tirofiban group had a significantly lower 30-day all-cause mortality (secondary end point; OR 0.63, 95% CI 0.40-0.90), compared with patients who were not administered tirofiban. At 1 year, a trend towards a lower all-cause mortality was observed in the tirofiban group (OR 0.74, 95% CI 0.53-1.04). No differences were found with respect to the TIMI major bleeding during the follow-up period.
  
  
  CONCLUSIONS
  Tirofiban administered with PPCI, following 600 mg clopidogrel pretreatment, improved primary efficacy outcome at 30 days and at 1 year follow up without an increase in major bleeding.
authors.affiliation: School of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Igor
authors.initials: I
authors.lastname: Mrdovic
authors.forename: Lidija
authors.initials: L
authors.lastname: Savic
authors.forename: Ratko
authors.initials: R
authors.lastname: Lasica
authors.forename: Gordana
authors.initials: G
authors.lastname: Krljanac
authors.forename: Milika
authors.initials: M
authors.lastname: Asanin
authors.forename: Natasa
authors.initials: N
authors.lastname: Brdar
authors.forename: Nemanja
authors.initials: N
authors.lastname: Djuricic
authors.forename: Jelena
authors.initials: J
authors.lastname: Marinkovic
authors.forename: Jovan
authors.initials: J
authors.lastname: Perunicic
mesh_terms: D000368:Aged; D000077144:Clopidogrel; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011300:Preoperative Care / Q000379:methods*; D057216:Propensity Score; D012042:Registries; D012189:Retrospective Studies; D055771:Serbia / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000077466:Tirofiban; D016896:Treatment Outcome; D014443:Tyrosine / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D014443:Tyrosine; D000077144:Clopidogrel; D000077466:Tirofiban; D013988:Ticlopidine
keywords: Efficacy outcome; glycoprotein IIb/IIIa inhibitor; primary PCI