Two-Year Follow-Up of Tirofiban-Based Management of Non-ST-Elevation Acute Coronary Syndrome-A Single Center Study

Background: The current practice guidelines suggest early and invasive strategies in treating patients of non ST-elevation acute coronary syndrome (NSTEACS) with high-risk profiles. However, the definite benefit and treatment protocols are still under debate. We conducted a tirofiban-based follow-up study to assess the effects of early-invasive strategy in NSTEACS. Methods: This was a prospective, open-label randomized trial. The study had a two-by-two factorial design, combining enoxaparin/unfractionated heparin and early-invasive/early-conservative strategies. The early-invasive arm mandated coronary angiography within 12 hours after randomization, while the counterpart took more than 48 hours. All enrolled patients received tirofiban at admission. The primary endpoint was composed of cardiovascular death, re-hospitalization due to recurrent angina, target vessel revascularization and unscheduled coronary bypass surgery in follow-up. The secondary endpoint concerned the bleeding complications. Results: After a 2-year follow-up of 61 eligible patients, the early-invasive arm did not show benefit over the early-conservative arm (RR=0.522, P=0.318; Kaplan Meier (KM) log-rank P=0.36) and enoxaparin was not superior to unfractionated heparin (RR=0.319, P=0.079; KM log-rank P=0.15). From another viewpoint, updated strategies utilizing either enoxaparin or early catheterization were better than the conventional one, which adopted unfractionated heparin and delayed angiography (RR=0.276, 95% CI 0.101-0.752, P=0.026; KM log-rank P=0.0026). There was no difference in bleeding complications. Conclusion: The updated treatment should be superior to the most conventional protocol in treating NSTEACS But, we cannot conclude that the early-invasive strategy benefits all NSTEACS patients more, especially when optimal adjunctive pharmacologic therapies are applied.