著者

Yen-Ting Yeh Jung-Chung Hsu Pen-Chih Liao Ai-Hsien Li Yuan-Hung Liu Kuo-Chin Chen Wenpo Chuang Shin-Rong Ke Yu-Wei Chiu Yen-Wen Wu

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.85, no.2, pp.166-174, 2021-01-25 (Released:2021-01-25)

参考文献数

21

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Background:Studies investigating the modulators of mortality benefit conferred by peri-angioplasty glycoprotein IIb/IIIa inhibitors in ST-elevation myocardial infarction (STEMI) are still lacking.Methods and Results:A prospective database (n=1,025) of consecutive cases undergoing primary percutaneous coronary intervention for STEMI was retrospectively analyzed. For patients in Killip class I, II or III, IV, the multivariate-adjusted hazard ratios of 30-day all-cause mortality associated with adjunctive tirofiban were 3.873 (95% CI 0.504–29.745; P=0.193), 0.550 (95% CI 0.188–1.609; P=0.275), and 0.264 (95% CI 0.099–0.704; P=0.008), respectively. The P value for a linear trend was 0.032. Patients who had a body mass index (BMI) within 22.9–25.0 kg/m2had a significant benefit from tirofiban (adjusted HR 0.344; 95% CI 0.145–0.814; P=0.015) compared to other BMI groups. The P value for a quadratic trend was 0.012. A novel Killip−BMI score (KBS = 2.5 × Killip category − | BMI − 24 |) was calculated to select the beneficial population. A KBS ≥2 was associated with significant mortality benefit, whereas a KBS <0 predicted increased 30-day mortality with tirofiban use.Conclusions:Survival benefit from peri-angioplasty tirofiban therapy for STEMI was positively correlated with the Killip class. Tirofiban should be used cautiously in either underweight or overweight patients. The novel KBS used in this study can guide peri-angioplasty use of adjunctive tirofiban in patients with STEMI undergoing primary angioplasty.