Modulators of mortality benefit from peri-angioplasty adjunctive tirofiban in patients with st-elevation myocardial infarction undergoing primary percutaneous coronary intervention
Journal
Circulation Journal
Journal Volume
85
Journal Issue
2
Pages
166-174
Date Issued
2021
Author(s)
Abstract
Background: Studies investigating the modulators of mortality benefit conferred by peri-angioplasty glycoprotein IIb/IIIa inhibitors in ST-elevation myocardial infarction (STEMI) are still lacking. Methods and Results: A prospective database (n=1,025) of consecutive cases undergoing primary percutaneous coronary intervention for STEMI was retrospectively analyzed. For patients in Killip class I, II or III, IV, the multivariate-adjusted hazard ratios of 30-day all-cause mortality associated with adjunctive tirofiban were 3.873 (95% CI 0.504–29.745; P=0.193), 0.550 (95% CI 0.188–1.609; P=0.275), and 0.264 (95% CI 0.099–0.704; P=0.008), respectively. The P value for a linear trend was 0.032. Patients who had a body mass index (BMI) within 22.9–25.0kg/m2 had a significant benefit from tirofiban (adjusted HR 0.344; 95% CI 0.145–0.814; P=0.015) compared to other BMI groups. The P value for a quadratic trend was 0.012. A novel Killip?BMI score (KBS=2.5×Killip category?|BMI?24|) was calculated to select the beneficial population. A KBS ?2 was associated with significant mortality benefit, whereas a KBS <0 predicted increased 30-day mortality with tirofiban use. Conclusions: Survival benefit from peri-angioplasty tirofiban therapy for STEMI was positively correlated with the Killip class. Tirofiban should be used cautiously in either underweight or overweight patients. The novel KBS used in this study can guide peri-angioplasty use of adjunctive tirofiban in patients with STEMI undergoing primary angioplasty. ? 2021 Japanese Circulation Society. All rights reserved.
Subjects
Glycoprotein IIb/IIIa inhibitor; Killip class; Percutaneous coronary intervention; ST-segment elevation myocardial infarction; Tirofiban
SDGs
Other Subjects
acetylsalicylic acid; aldosterone antagonist; angiotensin converting enzyme 2; beta adrenergic receptor blocking agent; clopidogrel; creatine kinase; creatinine; glycoprotein IIb; glycoprotein IIIa; hemoglobin; ticagrelor; tirofiban; antithrombocytic agent; tirofiban; adult; adult,human; all cause mortality; Article; body mass; coronary artery disease; diabetes mellitus; dyslipidemia; extracorporeal oxygenation; follow up; heart infarction; hospitalization; human; hypertension; leukocyte count; male; middle aged; mortality; obesity; percutaneous coronary intervention; ST segment elevation myocardial infarction; underweight; mortality; retrospective study; ST segment elevation myocardial infarction; transluminal coronary angioplasty; treatment outcome; Angioplasty, Balloon, Coronary; Humans; Percutaneous Coronary Intervention; Platelet Aggregation Inhibitors; Retrospective Studies; ST Elevation Myocardial Infarction; Tirofiban; Treatment Outcome
Type
journal article