Key result
High-dose tirofiban cuts 30-day MACE ~50% vs standard therapy in primary PCI for STEMI.
Why the study?
The safety and efficacy of high-dose tirofiban compared to standard care in patients undergoing primary PCI for STEMI needed evaluation.
Does high-dose tirofiban reduce 30-day MACE in patients undergoing primary PCI for STEMI?
RCT (n=600)
1:1 using a computer-generated randomization sequence with block sizes of four or six
No
Does high-dose tirofiban reduce 30-day MACE in patients undergoing primary PCI for STEMI?
Absolute Event Rate: 8.3% vs 16.7%
Number Needed to Treat: 12.5
p-value: p=0.012
High-dose tirofiban added to standard therapy during primary PCI for STEMI significantly reduces 30-day MACE, primarily driven by fewer target vessel revascularizations and repeat myocardial infarctions, without increasing bleeding risk.
Supports high-dose tirofiban in STEMI primary PCI; extends randomized evidence for intensified GP IIb/IIIa inhibition.
Background: The goal of this randomized controlled study was to evaluate the safety and efficacy of high-dose tirofiban compared to standard care in patients undergoing primary PCI for ST-segment elevation myocardial infarction (STEMI). Methods: This study was carried out at the Tertiary care hospital Rawalpindi (Pakistan) from June 2021 to December 2022. The administration of high-dose tirofiban or usual treatment was randomly assigned to a total of 600 individuals. The main outcome was the 30-day composite of major adverse cardiovascular events (MACE), that involved stroke, target vessel revascularization, repeat myocardial infarction, and all-cause mortality. Aside from problems related to bleeding, stent thrombosis was one of the secondary outcomes. Results: When compared to the group receiving conventional medication, the rate of the main endpoint was significantly reduced in the tirofiban group (5.7% vs. 10.3%, p=0.03). This was principally caused by a decline in target vessel revascularization and recurring myocardial infarction in the tirofiban category. In terms of stent thrombosis or hemorrhage problems, there wasn't no discernible difference among both groups. Conclusion: In patients receiving primary PCI for STEMI, high-dose tirofiban added to conventional treatment lowers the risk of MACE at 30 days.
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Sajjad et al. (2023) conducted an RCT in ST-segment elevation myocardial infarction (STEMI) (n=600). High-dose tirofiban vs. Standard therapy (aspirin, heparin, and P2Y12 inhibitors) was evaluated on 30-day composite of major adverse cardiovascular events (MACE), including stroke, target vessel revascularization, repeat myocardial infarction, and all-cause mortality (p=0.012). High-dose tirofiban significantly reduced the 30-day composite of major adverse cardiovascular events compared to standard therapy (8.3% vs 16.7%) in patients undergoing primary PCI for STEMI.
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