The clinical effect of tirofiban with low molecular weight heparin in patients with acute non-ST segment elevation myocardial infarction

Lim, Sang Yup; Bae, Eun Hui; Jeong, Myung Ho; Lee, Sang Hyun; Kim, Han Gyun; Lim, Ji Hyun; Park, Hyung Wook; Hong, Young Joon; Park, Ok Young; Kim, Ju Han; Kim, Weon; Ahn, Young Keun; Cho, Jeong Gwan; Park, Jong Chun; Kang, Jung Chaee

Abstract

BACKGROUN: Platelet activation and aggregation with resultant arterial thrombus formation play pivotal roles in the pathophysiology of acute coronary syndrome. We prospectively evaluated the long-term clinical effect of tirofiban, a specific inhibitor of the platelet glycoprotein IIb/IIIa receptor, with low molecular weight heparin (LMWH) in the treatment of non-ST segment elevation myocardial infarction (NSTEMI).
METHODS
We divided consecutive 90 patients with NSTEMI who underwent percutaneous coronary intervention (PCI) between August 2001 and April 2002 at Chonnam National University Hospital into 2 groups: Group I (n=45: LMWH alone, 62.3 +/- 9.8 years, 32 male) and II (n=45: tirofiban with LMWH, 59.2 +/- 10.2 years, 36 male). Major adverse cardiac events (MACE) were analyzed between two groups at 7 days after admission, and during 3-month and 6-month clinical follow-up.
RESULTS
Mean age, sex and risk factors were not different between two groups. Minor bleeding developed in 1 patient (2.2%) of each group (p=NS). Cardiac death occurred in 4 (8.9%) of group I and 3 patients (6.7%) of group II, and revascularization was required in one patient (2.2%) of each group until 7 days after admission (p=NS). During 3-month follow-up period, revascularization was required in 7 (15.6%) of group I and 5 patients (11.1%) of group II (p=NS). MACE during 6-month follow-up occurred in 11 patients (24.4%) of group I and 4 patients (8.9%) of group II (p=0.012): revascularization was required in 4 (8.9%), myocardial infarction occurred in 2 (4.4%), and cardiac death in 5 patients (11.1%) of group I, and revascularization in 1 (2.2%) and cardiac death in 3 patients (6.7%) of group II.
CONCLUSION
Tirofiban with LMWH is safe without significant bleeding complications and improve long-term prognosis in patients with NSTEMI underwent PCI.