Adjunctive tirofiban fails to reduce 30-day ischemic events in NSTE-ACS patients with complex coronary lesions after PCI: a retrospective cohort study

Background Preventing ischemic events is a critical concern for patients undergoing percutaneous coronary intervention (PCI). Glycoprotein IIb/IIIa inhibitors can significantly reduce short-term ischemic risk in ST-segment elevation myocardial infarction patients after PCI. However, their effectiveness in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients with complex lesions remains unclear. Methods This retrospective study included 1240 NSTE-ACS patients with complex coronary lesions. Patients receiving dual antiplatelet therapy (DAPT) after PCI, with or without tirofiban, were compared. The efficacy endpoint was a composite of 30-day ischemic events, while the safety endpoint was any occurrence of bleeding. Results The addition of tirofiban did not improve the 30-day ischemic outcomes among NSTE-ACS patients with complex lesions, and no significant enhancement was observed in these outcomes following multivariate adjustment (9.1% vs. 8.6%, P  = 0.745; adjusted HR: 1.219, P  = 0.342). The subgroup analyses showed consistent results. Although additional tirofiban treatment did not increase bleeding risk (3.8% vs. 3.4%, P  = 0.742), the medicine costs in the tirofiban group were significantly higher than those in the control group (¥2121 vs. ¥1579, P  < 0.001). Conclusions NSTE-ACS patients with complex lesions undergoing PCI may not benefit from additional tirofiban. However, the use of tirofiban significantly increased the medicine costs. The use of DAPT provides adequate antithrombotic protection in NSTE-ACS patients with complex lesions after PCI.