High-bolus dose tirofiban compared with abciximab in primary percutaneous coronary intervention: a propensity score-matched outcome study.
OBJECTIVE
The objective of this study was to analyse the outcomes of patients treated with high-bolus dose (HBD) tirofiban compared with abciximab at the time of primary PCI (PPCI) for ST-elevation myocardial infarction (STEMI).


RESULTS
Data from two large UK tertiary centres, with differing protocols for glycoprotein IIb/IIIa inhibitor use during PPCI, were pooled. Propensity scores were calculated based on important covariates, and HBD tirofiban-treated patients were matched to abciximab-treated controls on a one-to-one basis. This resulted in 942 well matched pairs. Survival analysis demonstrated no significant difference in mortality between HBD tirofiban and abciximab either at 30 days (HBD tirofiban 3.7% vs. abciximab 3.2%; HR 1.01 [95% CI: 0.92-1.10], p=0.96) or at three years (HBD tirofiban 9.4% vs. abciximab 9.3%; HR 1.15 [95% CI: 0.79-1.67], p=0.45). Rates of stent thrombosis at 30 days were also similar (HBD tirofiban 12 [1.3%] vs. abciximab 8 [0.8%], p=0.50) but thrombocytopaenia was more common with abciximab (HBD tirofiban 3 [0.3%] vs. abciximab 17 [1.8%], p=0.001).


CONCLUSIONS
In this observational study of adjunctive GP IIb/IIIa inhibitor treatment in PPCI, we found no difference in survival between HBD tirofiban-treated patients compared with propensity score-matched abciximab-treated controls up to three-year follow-up.
The James Cook University Hospital, Middlesbrough, United Kingdom.
David
D
Austin
Daniel F
DF
Mackay
Robert
R
Morley
James
J
Christie
Barry
B
Hennigan
Mark A
MA
de Belder
Jill P
JP
Pell
Keith G
KG
Oldroyd
D000077284:Abciximab; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D057216:Propensity Score; D016019:Survival Analysis; D013921:Thrombocytopenia / Q000139:chemically induced; D013927:Thrombosis / Q000517:prevention & control*; D000077466:Tirofiban; D014443:Tyrosine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D014443:Tyrosine; D000077466:Tirofiban; D000077284:Abciximab