Upstream use of Tirofiban in patients admitted for an acute coronary syndrome in hospitals with or without facilities for invasive management

Management and prognosis of acute coronary syndromes may be influenced by t he availability of catheterization facilities at admitting hospitals. Treat ment effects of tirofiban were examined in a Canadian cohort of 834 patient s enrolled in the Canadian Platelet Receptor Inhibition in Ischemic Syndrom e Management in patients Limited by Unstable Signs and Symptoms (PRISM-PLUS ) trial according to admission into hospitals without (n = 322) or with cat heterization facilities (n = 512). Hospital transfers for cardiac catheteri zation were facilitated using preexisting networks accelerated for the purp oses of the protocol. In hospitals without facilities, the relative risks f or occurrence of death, infarctian, or refractory ischemia among patients r eceiving tirofiban plus heparin compared with heparin alone were 0.52 at 7 days (p = 0.02), 0.59 at 30 days (p = 0.03), and 0.70 at 180 days (p = 0.09 ); and for death or infarction, 0.32 (p 0.02), 0.46 (p = 0.04,) and 0.51 (p = 0.03), respectively. Benefit was seen regardless of transfer status, wit h no statistically significant interaction between treatment, hospital type , and catheterization for any end point at any time point. The incidence of Thrombolysis In Infarction defined major bleeding with respect to therapy was not significantly different between hospital types. Thus, upstream trea tment with tirofiban plus heparin confers clinical benefits in unstable ang ina and/or non-ST-segment elevation infarction patients regardless of wheth er initial presentation is to a hospital without catheterization facilities or to a hospital with such facilities. (C) 2001 by Excerpta Medico, Inc.