IIb or Not IIb

Waksman, Ron

doi:10.1016/j.jacc.2009.12.058

Cited by 2 publications

(3 citation statements)

References 13 publications

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“…The average door-to-balloon time of our patients (Table 1) is much better than the 90-min target for optimal primary PCI outcomes (28), whereas the total ischemic time was beyond the goal of 120 min, according to the latest STEMI guidelines of the American Heart Association and American College of Cardiology (8, 28). …”

Section: Discussionmentioning

confidence: 79%

“…Current data on the timing of GPIs in relation to clinical benefit from pre-treatment with GPIs prior to hospital arrival or administration of the drug in the catheterization laboratory are controversial (7, 8). In this regard, tirofiban (Tiro), given in the ambulance, was shown to result in an improvement in ST-segment resolution as a marker for myocardial perfusion in patients with STEMI undergoing primary PCI (5).…”

Section: Introductionmentioning

confidence: 99%

“…In this regard, tirofiban (Tiro), given in the ambulance, was shown to result in an improvement in ST-segment resolution as a marker for myocardial perfusion in patients with STEMI undergoing primary PCI (5). Based on the ongoing debate considering the efficacy and timing of optimal GPI therapy for patients with STEMI undergoing primary PCI (8), the present study was designed to determine the effects of pre-, peri- and post-intervention tirofiban infusion on angiographic measures, ST-segment resolution, and clinical outcomes in patients with STEMI undergoing primary PCI.…”

Section: Introductionmentioning

confidence: 99%

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The effects of tirofiban infusion on clinical and angiographic outcomes of patients with STEMI undergoing primary PCI

Kaymaz¹,

Keleş²,

Özdemir³

et al. 2015

Anatol J Cardiol

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Objective:The present study was designed to determine the effects of tirofiban (Tiro) infusion on angiographic measures, ST-segment resolution, and clinical outcomes in patients with STEMI undergoing PCI. Glycoprotein (GP) IIb/IIIa inhibitors are beneficial in ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI), while the most effective timing of administration is still under investigation.Methods:A total of 1242 patients (83.0% males, mean (standard deviation; SD) age: 54.7 (10.9) years) with STEMI who underwent primary PCI were included in this retrospective non-randomized study in four groups, composed of no tirofiban infusion [Tiro (-); n=248], tirofiban infusion before PCI (pre-Tiro; n=720), tirofiban infusion during PCI (peri-Tiro; n=50), and tirofiban infusion after PCI (post-Tiro; n=224). In all Tiro (+) patients, bolus administration of Tiro (10 pg/kg) was followed by infusion (0.15 pg/kg/min) for a mean (SD) duration of 22.4±6.8 hours.Results:The pre-PCI Tiro group was associated with the highest percentage of patients with TIMI 3 flow (99.4%; p<0.001), the lowest corrected TIMI frame count [21(18-23.4); p<0.001], the highest percentage of patients with >75% ST-segment resolution (78.1%; p<0.001), and the lowest rate of in-hospital sudden cardiac death and in-hospital all-cause mortality (3.2%, p<0.05, 3.3%, p=0.01). Major bleeding was reported in 18 (1.8%) patients who received tirofiban.Conclusion:Use of standard-dose bolus tirofiban in addition to aspirin, high-dose clopidogrel, and unfractionated heparin prior to primary PCI significantly improves myocardial reperfusion, ST-segment resolution, in-hospital mortality rate, and in-hospital sudden cardiac death in patients with STEMI with no increased risk of major bleeding.

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Section: Discussionmentioning

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The effects of tirofiban infusion on clinical and angiographic outcomes of patients with STEMI undergoing primary PCI

Kaymaz¹,

Keleş²,

Özdemir³

et al. 2015

Anatol J Cardiol

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Glycoprotein IIb/IIIa Antagonists in Acute Coronary Syndromes Undergoing PCI: A Long Way to Select Optimal Agent and Route

Puddu

Schiariti

Bugiardini

2011

ISRN Vascular Medicine

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Antiplatelet treatment in patients with an acute coronary syndrome (ACS), without or with ST segment elevation myocardial infarction (STEMI), forces to keep the balance between potential threats and optimal clinical advantages. Apart from clopidogrel, glycoprotein (GP) IIb/IIIa inhibitors (abciximab and 2 small molecules, tirofiban and eptifibatide) have come to the clinical scene. Recent evidence (2009)(2010)(2011) is reviewed pointing to pharmacoeconometric considerations of concern in times of budget restrictions worldwide. In ACS, when clopidogrel plus aspirin are on, there might be no advantage to add small molecules. Whereas in STEMI patients treated by primary PCI, all 3 GP IIb/IIIa antagonists might be superimposable, when only ACS is present and PCI is elective, definite distinction among the 3 agents, both pharmacoeconomically and pharmacodynamically, might be invoked. There are still points open to debate. Among these the route (upstream versus downstream) is still a matter of uncertainties. Moreover, theoretically, there might be differences not only between abciximab and small molecules (mostly superimposable) but also between tirofiban and eptifibatide (the former being potentially more potent). Thus, a long way is needed before a prominent agent among GPIIb/IIIa inhibitors may be selected. The game is still open, a role will be played soon by new agents.

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IIb or Not IIb

Cited by 2 publications

References 13 publications

The effects of tirofiban infusion on clinical and angiographic outcomes of patients with STEMI undergoing primary PCI

The effects of tirofiban infusion on clinical and angiographic outcomes of patients with STEMI undergoing primary PCI

Glycoprotein IIb/IIIa Antagonists in Acute Coronary Syndromes Undergoing PCI: A Long Way to Select Optimal Agent and Route

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