Italian researchers have shown that in heart attack patients who have angioplasty, the anticoagulant drugs abciximab and tirofiban produce similar outcomes for certain cardiac measures within 90 minutes after the procedure.
The researchers also found that patients who received coated stents that released the drug sirolimus had a lower risk of major adverse cardiac events within eight months than patients who received uncoated stents.
Treatment with abciximab and implantation of an uncoated stent is a treatment strategy used to lessen the risk of major adverse cardiac events (MACE) in patients undergoing angioplasty for ST-segment elevation myocardial infarction (STEMI - a certain pattern on an electrocardiogram after a heart attack), according to background information in the study.
The researchers noted it hasn't been clear whether using tirofiban instead of abciximab would provide similar benefits. They added that the use of drug-eluting stents instead of uncoated stents in this patient population is discouraged because of safety concerns and conflicting evidence about efficacy.
In this study, Dr. Marco Valgimigli, of the Cardiovascular Institute at the University of Ferrara, and his colleagues compared high-dose tirofiban and sirolimus-releasing stents with abciximab infusion and uncoated stents in 745 patients with STEMI undergoing angioplasty.
They found that ST-segment elevation was reduced by at least 50 percent within 90 minutes after angioplasty in 83.6 percent of patients in the abciximab group and in 85.3 percent of those in the tirofiban group.
At 8 months, the MACE rate was similar among those who received tirofiban (9.9 percent) and those who received abciximab (12.4 percent) but was higher among those who were treated with the uncoated stent (54 patients, 14.5 percent) compared with those who were treated with the sirolimus-releasing stent (29 patients, 7.8 percent).
Revascularization (repeat procedure to unblock a blood vessel) was reduced from 10.2 percent with the uncoated stent to 3.2 percent with the sirolimus-releasing stent.
"In summary, our study provides evidence that in a broad population of largely unselected patients undergoing PCI for STEMI, tirofiban therapy is associated with a noninferior resolution from ST-segment elevation at 90 minutes postintervention compared with abciximab, and at 8-month follow-up, MACE are approximately halved by sirolimus-eluting stent implantation compared with uncoated stents," the authors wrote.
The study will be published in the April 16 issue of JAMA.