BMC Cardiovasc Disord. 2018;18(1):201.

Effect of tailored use of tirofiban in patients with Non-ST-elevation acute coronary syndrome undergoing percutaneous coronary intervention: a randomized controlled trial.

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제1저자 이원재, 서정원 · 교신저자 연태진

PMID 30348101 PMC6198526 DOI 10.1186/s12872-018-0938-6 IF 3.1 순환기내과

소속 (4)

Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University, Seongnam-si, Gyeonggi-do, Korea.
Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea.
Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University, Seongnam-si, Gyeonggi-do, Korea. ytjmd@snubh.org.
Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea. ytjmd@snubh.org.

Abstract

BACKGROUND We conducted a randomized controlled trial to investigate whether an additional platelet inhibition with tirofiban would reduce the extent of myocardial damage and prevent periprocedural myonecrosis in patients with Non-ST-elevation acute coronary syndrome (NSTE-ACS) with a high residual platelet activity (HPR).

METHODS Patients with an HPR, defined as P₂Y₁₂ reaction unit (PRU) > 230, were randomly assigned to group A (tirofiban treatment, n = 30) or C1 (n = 30) and patients without an HPR to C2 (n = 78). Periprocedural myocardial damage was assessed using the area under the curve (AUC) of serial cardiac enzyme levels from the time of the procedure to post-36 h. Periprocedural myonecrosis incidence was evaluated.

RESULTS The troponin I AUC was not different between the groups (197.2 [41.5395.7], 37.9 [8.9313.9], 121.3 [43.7481.8] h∙ng/mL; p = 0.088). The results did not change when the baseline levels were adjusted (365.3 [279.5, 451.1], 293.0 [207.1, 379.0], and 298.0 [244.7, 351.3] h∙ng/mL; p = 0.487). The rate of periprocedural myonecrosis was also not different between the groups (53.0% vs. 50.0% vs. 33.3%, p = 0.092). The CK-MB isoenzyme analysis showed similar results. No difference in complications was noted.

CONCLUSION Additional tirofiban administration was not beneficial to patients with NSTE-ACS even with an HPR.

TRIAL REGISTRATION Clinical trial no. NCT03114995 , registered 11 April, 2017, retrospectively.

Keywords

Glycoprotein IIb/IIIa inhibitorHigh residual platelet activityPeriprocedural myonecrosisTailored antiplatelet treatment

Figures

**Fig. 1** Study flow of the randomized controlled trial

**Fig. 2** Histogram showing the distribution of P₂Y₁₂ reaction units of all patients. The cut-off values of 230 and 252 are indicated to show the proportion of patients within the ranges

**Fig. 3** Comparison of area under curves of serial troponin I and creatine kinase-MB measurements between groups

**Fig. 4** Incidence of PMI by Troponin I and creatinine kinase-MB

**Fig. 5** Subgroup analysis in patients with platelet reactivity unit≥252 comparing area under curves of serial troponin I and creatine kinase-MB measurements between groups

그림 출처: PubMed Central 공개 논문 (PMC6198526)

Conflict of interest statement

ETHICS APPROVAL AND CONSENT TO PARTICIPATE: All informed written consents were obtained when enrolling the patients. and the study was authorized by Seoul National University Bundang Hospital Institutional Review Board. CONSENT FOR PUBLICATION: Not applicable COMPETING INTERESTS: The authors declare that they have no competing interests. PUBLISHER’S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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