Intracoronary thrombus and platelet glycoprotein IIb/IIIa receptor blockade with tirofiban in unstable angina or non-Q-wave myocardial infarction - Angiographic results from the PRISM-PLUS trial (Platelet receptor inhibitionfor ischemic syndrome management in patients limited by unstable signs andsymptoms)
Xq. Zhao et al., Intracoronary thrombus and platelet glycoprotein IIb/IIIa receptor blockade with tirofiban in unstable angina or non-Q-wave myocardial infarction - Angiographic results from the PRISM-PLUS trial (Platelet receptor inhibitionfor ischemic syndrome management in patients limited by unstable signs andsymptoms), CIRCULATION, 100(15), 1999, pp. 1609-1615
Citations number
29
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Background-The present study describes the effects of tirofiban, a nonpepti
de platelet glycoprotein (GP) IIb/IIIa receptor blocker, on the characteris
tics of culprit lesions in patients with unstable angina (UA) or non-Q-wave
myocardial infarction (NQWMI).
Methods and Results-Of 1915 patients enrolled in PRISM-PLUS, 1491 bad a rea
dable film obtained a median of 65 hours after randomization. A core labora
tory examined the culprit lesions for intracoronary thrombus burden (primar
y end point) and for TIMI flow grade distribution and severity of the obstr
uction and of underlying coronary artery disease (secondary end points). Th
e combination of tirofiban plus heparin compared with heparin alone signifi
cantly reduced the intracoronary thrombus burden of the culprit lesions (OR
= 0.77, P = 0.022), improved the perfusion grade (OR = 0.65, P = 0.002), a
nd decreased the severity of the obstruction (P = 0.037), but it did not in
fluence the severity of the underlying plaque. Persistence of a thrombus in
45% of patients was associated with a 2.4-fold increase in the odds of dea
th at 30 days (P = 0.005) and a 2-fold increase in the odds of myocardial i
nfarction (P = 0.002),
Conclusions-The addition of tirofiban to heparin reduced the thrombus burde
n of the culprit lesion and improved distal perfusion in patients with UA o
r NQWMI, which supports the clinical benefit observed with the combination
treatment.