Effects of Glycoprotein IIb/IIIa Receptor Inhibition with Tirofiban on Minor Myocardial Damage in Angiographically Successful Percutaneous Coronary Angioplasty

Abstract

Aim: The aim of the study was to evaluate the effects of glycoprotein (GP) IIb/IIIa inhibition on minor myocardial injury characterized by cardiac troponin I (cTn-I) and cardiac troponin T (cTn-T) elevation after elective successful percutaneous coronary intervention (PCI). Methods: The study consisted of 119 consecutive patients scheduled for elective coronary balloon angioplasty with or without stent implantation. Sixty-three patients (mean age 58 ± 9.4 years) were randomized to receive standard therapy, including preprocedural aspirin, ticlopidine and intravenous heparin, and 56 patients (mean age 55 ± 9.6 years) were randomized to additionally receive intravenous tirofiban infusion. cTn-I, cTn-T and CK-MB were measured before and immediately after the procedure, and every 6 h for the first 24 h. A total of 128 stenoses were treated with PCI. Seventy of these lesions were in the standard therapy group and 58 in the tirofiban group. Results: The frequency of postprocedural abnormal cTn-I levels was significantly higher in the standard therapy group than that in the tirofiban group (37 vs. 16%; p = 0.017). Postprocedural cTn-T elevation occurred in 23% of patients in the standard therapy group and in 8% of patients in the tirofiban group (p = 0.037). The frequencies of CK-MB elevation higher than the upper limit of normal (ULN), and higher than 2 times the ULN were not significantly different between the standard therapy and tirofiban groups (12 vs. 4%, and 7 vs. 2%, respectively). Conclusions: GP IIb/IIIa inhibition may reduce the incidence of minor myocardial injury, which may also be a possible mechanism in reducing long-term cardiac events after PCI.

Efficacy and Safety of Glycoprotein IIb/IIIa Inhibitors During Elective Coronary Revascularization

“…Safety. Major bleeding was reported in all but 7 trials (27)(28)(29)(30)(32)(33)(34). The incidence of major bleeding was 1.2% with GPI versus 0.9% with control (RR: 1.37, 95% CI: 0.83 to 2.25, p ϭ 0.22) (Fig.…”

“…Our search identified 22 studies with 10,123 patients (Fig. 1, Table 1) (10,11,(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40). The studies examined a variety of clinical outcomes, including 7 that used a nonclinical primary outcome (Table 2) (23,24,26,27,30,32,34).…”

Routine early versus deferred provisional tirofiban treatment in patients with acute coronary syndrome undergoing percutaneous coronary intervention

“…It has been reported that 74% of patients with aspirin and clopidogrel pretreatment show have troponin T levels 48 h after successful PCI . In patients pretreated with aspirin and clopidogrel, pretreatment with tirofiban was associated with early reinforced antiplatelet effects and the prevention of platelet thrombus formation, which consequently improved the myocardial blood supply and attenuated minor myocardial damage among NSTE‐ACS patients undergoing PCI . The EVEREST trial and a trial in China also showed that routine pretreatment with tirofiban significantly improves TIMI flow before PCI and reduces myocardial damage .…”

The sPLA 2 Inhibition to Decrease Enzyme Release After Percutaneous Coronary Intervention (SPIDER-PCI) Trial

“…In ARMYDA, atorvastatin reduced the release of CK-MB, troponin, and myoglobin compared with placebo. 15 Intracoronary propranolol, 21 celecoxib, 20 glycoprotein IIb/IIIa inhibitors, 18 and pyridoxal-5Ј-phosphate monohydrate 17 all reduced myocardial damage after PCI.…”

“…The sample size of previous studies 15,[17][18][19][20][21] testing interventions to reduce markers after elective PCI has ranged from 50 to 153 (mean, 105). The sample size used in ARMYDA was 153.…”