European Heart Journal Advance Access published online on September 14, 2009
European Heart Journal, doi:10.1093/eurheartj/ehp376
Tirofiban as adjunctive therapy for acute coronary syndromes and percutaneous coronary intervention: a meta-analysis of randomized trials
1 Cardiovascular Institute, Azienda Opedaliera Universitaria di Ferrara, Corso Giovecca 203, Ferrara 44100, Italy
2 Division of Cardiology, University of Turin, S. Giovanni Battista Hospital, Turin, Italy
3 Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands
4 Kerckhoff -Klinik GmbH, Bad Nauheim, Germany
5 St Antonius Ziekenhuis, Nieuwegein, The Netherlands
6 Cardiovascular Departments of San Donato Hospital, Arezzo, Italy
7 Istituto di Cardiologia, Università di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
8 Division of Cardiology, IRCCS, Fondazione Ospedale Maggiore Policlinico Mangiagalli e Regina Elena, Milan, Italy
9 Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy
10 Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey
11 Saint Joseph's Heart and Vascular Institute, Atlanta, GA, USA
12 Gill Heart Institute, University of Kentucky, Lexington, KY, USA
13 Scripps Translational Science Institute, Scripps Genomic Medicine, La Jolla, CA, USA
Received 12 February 2009; revised 26 August 2009; accepted 20 August 2009 * Corresponding author. Tel: +39 0532 202143, Fax: +39 0532 241885, Email: vlgmrc{at}unife.it
Aims: To perform a thorough and updated systematic review of randomized clinical trials comparing tirofiban vs. placebo or vs. abciximab.
Methods and results: We searched for randomized trials comparing tirofiban vs. placebo or any active control. Odds ratios (OR) were computed from individual studies and pooled with random-effect methods. Thirty-one studies were identified involving 20 006 patients (12 874 comparing tirofiban vs. heparin plus placebo or bivalirudin alone, and 7132 vs. abciximab). When compared with placebo, tirofiban was associated at 30 days with a significant reduction in mortality [OR = 0.68 (0.54–0.86); P = 0.001] and death or myocardial infarction (MI) [OR = 0.69 (0.58–0.81); P < 0.001]. The treatment benefit persisted at follow-up but came at an increased risk of minor bleedings [OR = 1.42 (1.13, 1.79), P = 0.002] or thrombocytopenia. When compared with abciximab, mortality at 30 days did not differ [OR = 0.90 (0.53, 1.54); P = 0.70], but in the overall group tirofiban trended to increase the composite of death or MI [OR = 1.18 (0.96, 1.45); P = 0.11]. No such trend persisted at medium-term follow-up or when appraising studies testing tirofiban at 25 µg/kg bolus regimen.
Conclusion: Tirofiban administration reduces mortality, the composite of death or MI and increases minor bleedings when compared with placebo. An early ischaemic hazard disfavouring tirofiban was noted when compared with abciximab in studies based on 10 but not 25 µg/kg tirofiban bolus regimen.
Key Words: Tirofiban • Abciximab • Glycoprotein IIb/IIIa inhibitors • Systematic review • Percutaneous coronary intervention