Comparison on the Effects of Clopidogrel Versus Tirofiban in Treating High-Risk Non-ST-Segment-Elevation Acute Coronary Syndromes: Risk-Adjusted Prospective Data Analysis

Abstract

AIM: To compare the outcomes of clopidogrel versus tirofiban in treating non-ST-segment elevation acute coronary syndromes among patients before percutaneous coronary intervention. METHODS: This was a prospective data bank analysis study with 342 patients (216 in the clopidogrel group and 126 in the tirofiban group) with high risk unstable angina (Braunwald/TIMI risk stratification) and/or non-ST acute myocardial infarction included between May 2010 and November 2012 who were receiving clopidogrel or tirofiban within the first 24 hours of admission and before percutaneous coronary intervention. The following data were obtained: age, sex, diabetes, systemic arterial hypertension, smoke, dyslipidemia, previous coronary artery disease (percutaneous coronary intervention or coronary artery bypass graft), hemoglobin, creatinine, higher troponin, left ventricle ejection fraction and medication used at hospital. The primary endpoint was all cause of in hospital death and major adverse cardiac events (MACE) (death, non-fatal unstable angina or myocardial infarction/ targed vessel revascularization, Killip III/IV, bleeding and stroke). Comparison between groups was made by Anova and Q-square. Multivariative analysis were determined by logistic regression and was considered significative when p<0.05. RESULTS: The median age was 64 years and 60.5% were male. In the tirofiban group were observed higher troponin levels (p=0.02), higher prevalence in previous coronary artery disease (p=0.02) and differences between use of enoxaparin (92% in the tirofiban group×85% in the clopidogrel group, p=0.02). No significant difference was observed between the tirofiban versus clopidogrel groups in deaths (15.8%×8.3%, p=0.14) and MACE (29.4%×20.4%, p=0.72). CONCLUSIONS: In patients with high risk non-ST acute coronary syndromes, the use of clopidogrel or tirofiban in the first 24 hours of admission were similar and the result did not show statistical significance difference between groups regarding mortality and MACE, despite higher tendency of that in tirofiban group.