Periprocedural use of tirofiban in elective percutaneous coronary intervention for long coronary lesions in stable patients with overlapping drug-eluting stents--the PETITION study: a prospective, randomized, multicenter study.
BACKGROUND AND PURPOSE
Patients are at risk of developing periprocedural myonecrosis after percutaneous coronary intervention (PCI). We investigated whether the use of the platelet glycoprotein (GP) IIb/IIIa receptor inhibitor tirofiban could reduce periprocedural myocardial infarction (PMI) in patients with stable coronary artery disease undergoing elective PCI with overlapping stent implantation for long lesions.


METHODS
A total of 748 stable angina patients with long lesions (≥ 40 mm in length) treated with overlapping stent implantation were randomly assigned to receive tirofiban (tirofiban group; n = 373) or conventional therapy (control group; n = 375). Intravenous tirofiban was initiated before PCI and maintained for 12 hr after the procedure. The primary endpoint was PMI, defined as an elevation in CK-MB > 3 times the upper limit of normal 12 hr after the index procedure. The secondary endpoint was major adverse cardiac events (MACE), including cardiac death, target vessel revascularization, and recurrent MI (re-MI), at one-year of clinical follow-up. The safety end-points included Thrombolysis in Myocardial Infarction (TIMI) major bleeding and stent thrombosis.


RESULTS
Despite comparable angiographic and procedural characteristics, in the intention-to-treatment analysis, the primary endpoint was significantly reduced in the tirofiban group (4.0% vs. 11.5%, P < 0.001). Multivariate analysis revealed that the adjunctive use of tirofiban was the only negative predictor of PMI (OR 0.41, 95% CI 0.28-0.81, P < 0.01). At one-year of clinical follow-up, the overall occurrence of MACE was significantly lower in the tirofiban group (13.4% vs. 22.7%, P = 0.001). The rate of TIMI major bleeding and stent thrombosis did not differ significantly between the two groups.


CONCLUSION
Our results show that the adjunctive use of tirofiban reduces the occurrence of PMI and MACE at one year in stable coronary artery disease patients undergoing elective PCI for long lesions with overlapping stent implantation.
['Zhang|Qi|Q|', 'Wang|Xiao Long|XL|', 'Liao|Min Lei|ML|', 'Hu|Jian|J|', 'Yang|Zhen Kun|ZK|', 'Ding|Feng Hua|FH|', 'Zhang|Jian Sheng|JS|', 'Du|Run|R|', 'Zhu|Tian Qi|TQ|', 'Shen|Wei Feng|WF|', 'Zhang|Rui Yan|RY|']
D000368:Aged D015415:Biomarkers D016009:Chi-Square Distribution D002681:China D017023:Coronary Angiography D003324:Coronary Artery Disease D003328:Coronary Thrombosis D052279:Creatine Kinase, MB Form D054855:Drug-Eluting Stents D005260:Female D006470:Hemorrhage D006801:Humans D057194:Intention to Treat Analysis D053208:Kaplan-Meier Estimate D008297:Male D008875:Middle Aged D015999:Multivariate Analysis D009203:Myocardial Infarction D016017:Odds Ratio D062645:Percutaneous Coronary Intervention D010975:Platelet Aggregation Inhibitors D019039:Platelet Glycoprotein GPIIb-IIIa Complex D011446:Prospective Studies D011474:Prosthesis Design D012307:Risk Factors D013997:Time Factors D000077466:Tirofiban D016896:Treatment Outcome D014443:Tyrosine D015854:Up-Regulation
percutaneous coronary intervention myocardial infarction coronary artery disease stable angina GP IIb/IIIa inhibitor