High Dose Tirofiban is similar to Abciximab in reducing Major Adverse Cardiac Events

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March 30, 2008 By Alexandra M. Palmer [1]

SCAI-ACCi2 08-Chicago, IL: The Multistrategy study demonstrates that high dose tirofiban is non-inferior to abciximab during primary PCI for acute myocardial infarction. Placement of Sirolimus eluting stents were associated with a significant reduction in major adverse cardiac events when compared to bare metal stents. The data was presented by Dr. Marco Valgimigli at the at the SCAI-ACC i2 summit Annual Scientific Sessions in Chicago today.

The goal of this trial was to evaluate the risks and benefits of administering tirofiban at high bolus dose (25μg/Kg over 3 minutes) followed by a standard infusion rate vs abciximab. In addition, the study set out to assess the efficacy of drug-eluting stents in the setting of ST elevation MI. In the comparison of tirofiban and abciximab, the primary endpoint was the incidence of a ≥50% reduction in ST segment elevation. In the stent arm the primary endpoint consisted of major adverse cardiac events (MACE) which included death, reinfarction and target vessel revascularization at 8 months.

The study enrolled 745 STEMI patients at 16 centers. Patients were randomized to 4 different arms: Abciximab and bare metal stent-BMS (n=186), abciximab and sirolimus-eluting stent (n=187), tirofiban and bare metal stent (n=186), and tirofiban and sirolimus-eluting stent (n=186).

There was no significant difference in % ST segment resolution between the tirofiban and the abciximab groups [n=722, 85.3% vs. 83.6%, (95% CI, 0.958-1.086)]. There was also no significant difference in the incidence of the efficacy endpoints such as MACE (p=0.85), death/MI (p=0.98), urgent target vessel revascularization (p=0.59), and stent thrombosis (definite, p=0.56) at 30 days and at 8 months (overall MACE 9.8% vs. 12.4%, p=0.3) between tirofiban and abciximab. However, thrombocytopenia was more prevalent among patients treated with abciximab as compared to those treated with tirofiban (4.0% vs. 0.8%, p=0.004) with no difference in major bleeding (p=0.44).

Placement of Sirolimus stents compared with BMS was associated with significant reduction in the occurrence of MACE [7.8% vs. 14.5%, HR 0.53 (97.5% CI 0.33-0.83), p=0.006] at 8 months following primary PCI with no increase in the occurrence of stent thrombosis (definite, p=0.65).

Investigators conclude that among patients with ST elevation MI, high dose tirofiban administration is associated with non-inferior ST-segment resolution at 90 minutes when compared with abciximab. There was also no difference in the 30 day efficacy MACE between tirofiban and abciximab.

Sources

1. Valgimigli Marco, Gianfranco Percoco, Gianluca Campo, Leonardo Bolognese, Maurizio Anselmi, Salvatore Colangelo, Nicoletta de Cesare, Alfredo E. Rodriguez, Maurizio Ferrario, Raul Moreno, Tommaso Piva, Imad Sheiban. Giampaolo Pasquetto, Francesco Prati, Marco Nazzario, Roberto Ferrari.
2. Late Breaking Clinical Trials Session: SCAI Annual Scientific Sessions in partnership with ACC i2 summit, March 29-April 1, 2008 Chicago
3. SCAI-ACC i2 press release

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Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .