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

BackgroundWe 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).MethodsPatients 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-36h. Periprocedural myonecrosis incidence was evaluated.ResultsThe 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.ConclusionAdditional tirofiban administration was not beneficial to patients with NSTE-ACS even with an HPR.Trial registrationClinical trial no. NCT03114995, registered 11 April, 2017, retrospectively.