High-bolus dose tirofiban compared with abciximab in primary percutaneous coronary intervention: a propensity score-matched outcome study

Aims: The objective of this study was to analyse the outcomes of patients treated with high-bolus dose (HBD) tirofiban compared with abciximab at the time of primary PCI (PPCI) for ST-elevation myocardial infarction (STEMI). Methods and results: Data from two large UK tertiary centres, with differing protocols for glycoprotein Ilb/IIIa inhibitor use during PPCI, were pooled. Propensity scores were calculated based on important covariates, and HBD tirofiban-treated patients were matched to abciximab-treated controls on a one-to-one basis. This resulted in 942 well matched pairs. Survival analysis demonstrated no significant difference in mortality between HBD tirofiban and abciximab either at 30 days (HBD tirofiban 3.7% vs. abciximab 3.2%; HR 1.01 [95% CI: 0.92-1.10], p=0.96) or at three years (HBD tirofiban 9.4% vs. abciximab 9.3%; HR 1.15 [95% CI: 0.79-1.67], p=0.45). Rates of stent thrombosis at 30 days were also similar (HBD tirofiban 12 [1.3%] vs. abciximab 8 [0.8%], p=0.50) but thrombocytopaenia was more common with abciximab (HBD tirofiban 3 [0.3%] vs. abciximab 17 [1.8%], p=0.001). Conclusions: In this observational study of adjunctive GP Ilb/IIIa inhibitor treatment in PPCI, we found no difference in survival between HBD tirofiban-treated patients compared with propensity score-matched abciximab-treated controls up to three-year follow-up.