Key result
Upstream administration of tirofiban reduced 1-month major adverse cardiac events compared to deferred injection (3.3% vs. 7.0%, P=0.034) in STEMI patients undergoing primary PCI.
Why the study?
Does upstream administration of tirofiban reduce major adverse cardiac events compared to deferred administration in patients with acute STEMI undergoing primary PCI?
RCT (n=660)
Does upstream administration of tirofiban reduce major adverse cardiac events compared to deferred administration in patients with acute STEMI undergoing primary PCI?
Absolute Event Rate: 3.3% vs 7%
p-value: p=0.034
Upstream administration of tirofiban in the emergency room may improve short-term clinical outcomes and LVEF compared to deferred administration during PCI in STEMI patients, without a statistically significant increase in bleeding.
Upstream tirofiban was associated with lower 1-month MACE in STEMI PCI; hypothesis-generating and requires randomized confirmation before practice change.
BACKGROUND: High bolus dose tirofiban has been demonstrated to provide greater inhibition of platelet aggregation, but the most appropriate timing of its administration remains unknown. OBJECTIVES: To evaluate the efficacy of upstream vs. deferred administration of tirofiban in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI) on clinical outcomes. METHODS: The 660 patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention were divided into upstream (n=330, administration of tirofiban to all patients in emergency room) and deferred groups (n=330, treatment of patients with large thrombus burden or no-reflow phenomenon in cardiac catheterization laboratory during PCI). The primary end-points were death, nonfatal myocardial infarction (MI), stent thrombosis (ST), revascularization of targeted vessels (TVR) or major adverse cardiac events (MACE) at 1 month and 6 months following PCI, with safety end-point at 7 days. RESULTS: Compared with that of the deferred group, there was a significant increase of left ventricular ejection fraction (LVEF) in the upstream group within 7 days (55.5 ± 6.6% vs. 54.6 ± 7.9%, P=0.011). The rates of 7-day and 1-month MACE in the upstream group were lower than those in the deferred group (1.5% vs. 4.2%, 3.3% vs. 7.0%, P=0.037 and 0.034, respectively). However, there were higher tendencies for major and minor bleedings in the upstream group (1.8% vs. 0.9%, 2.7% vs. 1.5%, P=0.315 and 0.280, respectively). CONCLUSION: To the Chinese patients with acute myocardial infarction undergoing primary PCI, upstream administration of tirofiban was slightly superior to deferred injection for short-term clinical outcomes.
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Jia et al. (2013) conducted an RCT in Acute ST-segment elevation myocardial infarction (n=660). Upstream administration of tirofiban vs. Deferred administration of tirofiban was evaluated on Death, nonfatal myocardial infarction (MI), stent thrombosis (ST), revascularization of targeted vessels (TVR) or major adverse cardiac events (MACE) at 1 month and 6 months following PCI (p=0.034). Upstream administration of tirofiban reduced 1-month major adverse cardiac events compared to deferred injection (3.3% vs. 7.0%, P=0.034) in STEMI patients undergoing primary PCI.
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