Background Diabetes is strongly associated with clopidogrel resistance, thrombosis and the development of coronary artery disease (CAD). Some trials suggest that inhibition of glycoprotein IIb/IIIa can improve the outcome of clopidogrel resistance in patients undergoing percutaneous coronary interventions (PCIs). However, the efficacy of small-molecule IIb/IIIa receptor inhibitors in acute coronary syndrome (ACS) patients with diabetes undergoing PCI has not been specifically investigated.
Methods We randomised consecutive ACS patients with diabetes undergoing PCI, to tirofiban or placebo groups along with double antiplatelet therapy. High-dose bolus (20 mg/kg per 3 min) of tirofiban was administered immediately before PCI followed by 8 h continuous infusion (0.15 mg/kg per min). Postprocedural myocardial necrosis was assessed prospectively by measurement of cardiac troponin I (cTnI) at 6 and 24 h after PCI. The primary end-points were post-PCI coronary flow estimated by corrected TIMI frame count and post-PCI myocardial infarction.
Result 138 patients entered the study (66 randomised to placebo and 72 randomised to tirofiban). Post-PCI corrected TIMI frame count was 9.2±3.6 in tirofiban and 13.0±7.6 in placebo groups (p=0.03). The prevalence of post-PCI myocardial infarction was similar in the two groups (17 vs 26%, p=0.167, respectively).
Conclusion Up-stream use of tirofiban in ACS patients with diabetes undergoing PCI, along with double antiplatelet therapy, was associated with a decreased risk of distal embolisation.
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