Key result
Routine upstream tirofiban cuts enzymatic infarct size ~34% vs selective downstream use in NSTE-ACS.
Why the study?
Glycoprotein IIb/IIIa blockers are underused in daily practice for NSTE ACS patients despite guideline recommendations and proven benefits.
Does routine upstream use of tirofiban reduce enzymatic infarct size in patients with NSTE ACS scheduled for early invasive therapy compared to selective downstream use?
Comparison
Routine upstream tirofiban vs selective downstream tirofiban
Design
Combined analysis of two randomized controlled trials
Authors
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May support upstream tirofiban in selected NSTE ACS; extends meta-analytic evidence for early GP IIb/IIIa use.
RCT (n=548)
Open-label with blinded outcome assessment
Randomized
No
Does routine upstream use of tirofiban reduce enzymatic infarct size in patients with NSTE ACS scheduled for early invasive therapy compared to selective downstream use?
Absolute Event Rate: 125% vs 189%
p-value: p=0.006
Routine upstream use of tirofiban reduces enzymatic infarct size and improves initial culprit lesion patency in NSTE ACS patients, particularly those with elevated troponin and without clopidogrel pretreatment.
Rasoul et al. (2007) conducted an RCT in Non-ST elevation acute coronary syndrome (NSTE ACS) (n=548). Routine upstream tirofiban vs. Selective downstream use of tirofiban was evaluated on Enzymatic infarct size (cumulative release of LDH during the first 48 h after admission, LDHQ48) (p=0.006). Routine upstream use of tirofiban significantly reduced enzymatic infarct size (median 125 vs 189 IU/l, P=0.006) compared to selective downstream use in patients with non-ST elevation acute coronary syndrome.
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