Effects of Bailout Tirofiban on In-Hospital Outcomes and Long-Term Mortality in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Intervention

Abstract

We retrospectively analyzed short- and long-term outcomes of patients who received bailout tirofiban during primary percutaneous intervention (pPCI). A total of 2681patients who underwent pPCI between 2009 and 2014 were analyzed; 1331 (49.6%) out of 2681 patients received bailout tirofiban. Using propensity score matching, 2100 patients (1050 patient received bail-out tirofiban) with similar preprocedural characteristics were identified. Patients who received bailout tirofiban had a significantly higher incidence of acute stent thrombosis, myocardial infarction, and major cardiac or cerebrovascular events during the in-hospital period. There were numerically fewer deaths in the bailout tirofiban group in the unmatched cohort (1.7% vs 2.5%, P = .118). In the matched cohort, in-hospital mortality was significantly lower (1.1% vs 2.4%, P = .03), and survival at 12 and 60 months were higher (96.9% vs 95.2%, P = .056 for 12 months and 95.1% vs 92.0%, P = .01 for 60 months) in the bailout tirofiban group. After multivariate adjustment, bailout tirofiban was associated with a lower mortality at 12 months (odds ratio [OR]: 0.554, 95% confidence interval [CI], 0.349-0.880, P = .012) and 60 months (OR: 0.595, 95% CI, 0.413-0.859, P = .006). In conclusion, bailout tirofiban strategy during pPCI is associated with a lower short- and long-term mortality, although in-hospital complications were more frequent.

Efficacy and Safety of Glycoprotein IIb/IIIa Inhibitors on Top of Ticagrelor in STEMI: A Subanalysis of the ATLANTIC Trial

“…15 A retrospective study using propensity score matching suggests beneficial effects of bailout GPI on long-term mortality. 40 A trial randomizing GPI compared with no GPI in bailout situations may further improve our knowledge of the potential beneficial effects of bailout GPI, though this kind of trial design may raise ethical concerns.…”

Effect of Tirofiban Injection on vascular endothelial function, cardiac function and inflammatory cytokines in patients with acute myocardial infarction after emergency Percutaneous Coronary Intervention

“…16 Tirofiban can block the binding of coagulation cytokines and platelet glycoproteins (IIb/ IIIa), thereby exerting a role of antiplatelet and anticoagulant. 17 Indexes of LVEDD and LVEF in the experimental group at 1 week and 1 month after treatment were significantly lower than those in the control group, with a statistical significance (p=0.00). Moreover, the incidence of ST-segment fallback > 70% in the experimental group was 72.5% after treatment, which was significantly better than that of 47.5% in the control group, with a statistically significant difference (p=0.03).…”

“…Tirofiban can block the binding of coagulation cytokines and platelet glycoproteins (IIb/IIIa), thereby exerting a role of antiplatelet and anticoagulant. 17 Furthermore, tirofiban has been touted for its efficacy in degrading formed thrombus, reducing microvascular injury and preventing cardiovascular embolism events. 18 It is considered by Liu et al 19 that tirofiban hydrochloride sodium chloride injection combined with cardiovascular intervention has important clinical effects in the treatment of acute myocardial infarction.…”

Efficacy and safety of glycoprotein IIb/IIIa inhibitors in addition to P2Y12 inhibitors in ST‐segment elevation myocardial infarction: A subanalysis of the POPular Genetics trial

“…This could reflect the high‐risk status of patients requiring bail‐out GPI. In a subanalysis of the CHAMPION‐PHOENIX trial, bail‐out GPI use was associated with lower mortality in STEMI patients compared to no GPI administration based on a propensity matching analysis 26 . Therefore, the administration of GPI as a bail‐out strategy is still viable to consider, which is in accordance with the guidelines 9,10 .…”