Aim: This study aimed to compare
the efficacy and safety between standard and low-dose tirofiban in the treatment of elderly high-risk non-ST-segment elevation acute coronary
syndrome (NSTE-ACS) patients who underwent percutaneous coronary intervention (PCI).
Methods: Ninety-four very elderly
(?0 years) high-risk patients with NSTE-ACS were randomly assigned to the
standard or the low-dose group. Upstream tirofiban was administered
intravenously with a bolus dose of 0.4 µg·kg-1·min-1 over
a period of 30 min after the diagnosis had been confirmed, and was followed by
a 36−48 h infusion of 0.10 µg·kg-1·min-1 or 0.075 µg·kg-1·min-1. PCI was performed within 24 h of
admission. Platelet aggregation
inhibition and thrombolysis in myocardial infarction
(TIMI) grade flow were assessed. The major adverse cardiac events (MACEs),
including death, myocardial infarction, recurrent angina and urgent
target-vessel revascularization (TVR), were documented at 7 d, 30 d, and 6
months, and bleeding events were recorded at 7 d.
Results: Although a significantly
higher inhibition of platelet aggregation was observed in the standard-dose
group (P<0.05), angiographic PCI success was similar between the two
groups (P>0.05). The rate
of MACEs was not significantly different at 7 days
(2.1% vs 4.4%, P=0.61), 30 days (6.3% vs 8.7%, P=0.71) and 6 months (14.6% vs 17.4%, P=0.71). Major bleeding events were significantly
higher in the standard-dose group (10.4% vs 0.0%, P=0.03).
Conclusion: In very elderly high-risk
patients with NSTE-ACS undergoing PCI, low-dose tirofiban offered about the same level of protection from major ischemic events that
standard doses did, with less associated bleeding. |
