CLINICAL STUDY: ADJUNCTIVE THERAPY AND PCI
effect of additional temporary glycoprotein IIb/IIIa receptor inhibition on troponin release in elective percutaneous coronary interventions after pretreatment with aspirin and clopidogrel (TOPSTAR trial)
Andreas W. Bonz, MD*,*,
Björn Lengenfelder*,
J.örg Strotmann, MD*,
Stefanie Held, MD*,
Oliver Turschner, MD*,
Kerstin Harre, MD*,
Christian Wacker, MD*,
Christiane Waller, MD*,
Nikolaus Kochsiek, MD*,
Malte Meesmann, MD*,
Ludwig Neyses, MD*,
Peter Schanzenbächer, MD*,
Georg Ertl, MD* and
Wolfram Voelker, MD*
* Department of Cardiology, University of Würzburg, Würzburg, Germany
Manuscript received October 16, 2001;
revised manuscript received April 16, 2002,
accepted May 15, 2002.
* Reprint requests and correspondence: Dr. Andreas W. Bonz, Medizinische Universitätsklinik, Josef Schneider Strasse 2, 97080 Würzburg, Germany.
a.bonz{at}medizin.uni-wuerzburg.de
OBJECTIVES: The Troponin in Planned PTCA/Stent Implantation With or Without Administration of the Glycoprotein IIb/IIIa Receptor Antagonist Tirofiban (TOPSTAR) trial investigated: 1) the amount of troponin T (TnT) release after nonacute, elective percutaneous coronary intervention (PCI) in patients pretreated with aspirin and clopidogrel; and 2) the effect of additional glycoprotein (GP) IIb/IIIa receptor inhibiton on postinterventional TnT release.
BACKGROUND: No data are available yet as to whether additional administration of a GP IIb/IIIa receptor antagonist might be beneficial in patients undergoing elective PCI already pretreated with aspirin and clopidogrel.
METHODS: After bolus application of the study medication (tirofiban [T] or placebo [P]), PCI was performed followed by an 18-h continuous infusion of T/P. Primary end point of the study was incidence and amount of TnT release after elective PCI after 24 h.
RESULTS: A total of 12 h after PCI troponin release was detected in 63% of the patients receiving P and in 40% of the patients receiving T (p < 0.05), after 24 h in 69% (P) and 48% (T) (p < 0.05) and after 48 h in 74% (P) versus 58% (T) (p < 0.08) of the patients. No differences were observed regarding major bleeding, intracranial bleeding or nonhemorrhagic strokes. After nine months a reduction of combined death/myocardial infarction/target vessel revascularization could be observed in the tirofiban group ([T] 2.3% vs. [P] 13.04%, p < 0.05).
CONCLUSIONS: Troponin T release occurs after successful intervention in 74% of the patients undergoing elective PCI after 48 h even after pretreatment with aspirin and clopidogrel. The GP IIb/IIIa receptor antagonist tirofiban is able to decrease the incidence of troponin release significantly in this patient population.
|
Abbreviations and Acronyms
| | ACT | | activated clotting time | | CK | | creatine kinase | | GP | | glycoprotein | | MI | | myocardial infarction | | P | | placebo group | | PAU | | platelet aggregation units | | PCI | | percutaneous coronary intervention | | PTCA | | percutaneous transluminal coronary angioplasty | | RPFA | | rapid platelet function assay | | T | | tirofiban group | | TnT | | troponin T | | TOPSTAR | | Troponin in Elective PTCA/STent Implantation With or Without Administration of the Glycoprotein IIb/IIIa Receptor Antagonist Tirofiban | | TVR | | target vessel revascularization |
|
This article has been cited by other articles:
|
|
|
|
 
A. Y. Fung, J. Saw, A. Starovoytov, C. Densem, P. Jokhi, S. J. Walsh, R. S. Fox, K. H. Humphries, E. Aymong, D. R. Ricci, et al.
Abbreviated infusion of eptifibatide after successful coronary intervention The BRIEF-PCI (Brief Infusion of Eptifibatide Following Percutaneous Coronary Intervention) randomized trial.
J. Am. Coll. Cardiol.,
March 10, 2009;
53(10):
837 - 845.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Uetani, T. Amano, S. Kumagai, H. Ando, K. Yokoi, T. Yoshida, B. Kato, M. Kato, N. Marui, M. Nanki, et al.
Intracoronary Electrocardiogram Recording With a Bare-Wire System: Perioperative ST-Segment Elevation in the Intracoronary Electrocardiogram Is Associated With Myocardial Injury After Elective Coronary Stent Implantation
J. Am. Coll. Cardiol. Intv.,
February 1, 2009;
2(2):
127 - 135.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. M. O'Riordan, R. J. Margey, G. Blake, and P. R. O'Connell
Antiplatelet Agents in the Perioperative Period
Arch Surg,
January 1, 2009;
144(1):
69 - 76.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Jaffe, T. Charron, G. Puley, A. Dick, and B. H. Strauss
Microvascular Obstruction and the No-Reflow Phenomenon After Percutaneous Coronary Intervention
Circulation,
June 17, 2008;
117(24):
3152 - 3156.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. J. Kereiakes and P. A. Gurbel
Peri-Procedural Platelet Function and Platelet Inhibition in Percutaneous Coronary Intervention
J. Am. Coll. Cardiol. Intv.,
April 1, 2008;
1(2):
111 - 121.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
O. F. Bertrand, R. De Larochelliere, J. Rodes-Cabau, G. Proulx, O. Gleeton, C. Manh Nguyen, J.-P. Dery, G. Barbeau, B. Noel, E. Larose, et al.
A Randomized Study Comparing Same-Day Home Discharge and Abciximab Bolus Only to Overnight Hospitalization and Abciximab Bolus and Infusion After Transradial Coronary Stent Implantation
Circulation,
December 12, 2006;
114(24):
2636 - 2643.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. E. Bertrand and E. Van Belle
Triple antiplatelet treatment in patients presenting with non-ST-segment elevation acute coronary syndromes
Eur. Heart J. Suppl.,
October 1, 2006;
8(suppl_G):
G59 - G63.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. L. Miller, K. N. Garratt, M. F. Burritt, R. J. Lennon, G. S. Reeder, and A. S. Jaffe
Baseline troponin level: key to understanding the importance of post-PCI troponin elevations
Eur. Heart J.,
May 1, 2006;
27(9):
1061 - 1069.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Herrmann
Peri-procedural myocardial injury: 2005 update
Eur. Heart J.,
December 1, 2005;
26(23):
2493 - 2519.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. P. Giugliano and E. Braunwald
The Year in Non--ST-Segment Elevation Acute Coronary Syndromes
J. Am. Coll. Cardiol.,
September 6, 2005;
46(5):
906 - 919.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. J. Claeys, M. G. Van der Planken, J. M. Bosmans, J. J. Michiels, F. Vertessen, P. Van Der Goten, F. L. Wuyts, and C. J. Vrints
Does pre-treatment with aspirin and loading dose clopidogrel obviate the need for glycoprotein IIb/IIIa antagonists during elective coronary stenting? A focus on peri-procedural myonecrosis
Eur. Heart J.,
March 2, 2005;
26(6):
567 - 575.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Valgimigli, G. Percoco, D. Barbieri, F. Ferrari, G. Guardigli, G. Parrinello, O. Soukhomovskaia, and R. Ferrari
The additive value of tirofiban administered with the high-dose bolus in the prevention of ischemic complications during high-risk coronary angioplasty: The advance trial
J. Am. Coll. Cardiol.,
July 7, 2004;
44(1):
14 - 19.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Dalby, G. Montalescot, C. B. d. Sollier, E. Vicaut, T. Soulat, J.-P. Collet, R. Choussat, V. Gallois, G. Drobinski, L. Drouet, et al.
Eptifibatide provides additional platelet inhibition in Non-ST-Elevation myocardial infarction patients already treated with aspirin and clopidogrel: Results of the platelet activity extinction in Non-Q-Wave myocardial infarction with aspirin, clopidogrel, and eptifibatide (PEACE) study
J. Am. Coll. Cardiol.,
January 21, 2004;
43(2):
162 - 168.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. L. Miller, K. N. Garratt, M. F. Burritt, G. S. Reeder, and A. S. Jaffe
Timing of Peak Troponin T and Creatine Kinase-MB Elevations After Percutaneous Coronary Intervention
Chest,
January 1, 2004;
125(1):
275 - 280.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. P. Cannon and A. G.G. Turpie
Unstable Angina and Non-ST-Elevation Myocardial Infarction: Initial Antithrombotic Therapy and Early Invasive Strategy
Circulation,
June 3, 2003;
107(21):
2640 - 2645.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. R. Steinhubl, P. B. Berger, J. T. Mann III, E. T. A. Fry, A. DeLago, C. Wilmer, E. J. Topol, and for the CREDO Investigators
Early and Sustained Dual Oral Antiplatelet Therapy Following Percutaneous Coronary Intervention: A Randomized Controlled Trial
JAMA,
November 20, 2002;
288(19):
2411 - 2420.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Troponin T Release After Elective PCI
Journal Watch Cardiology,
November 1, 2002;
2002(1101):
3 - 3.
[Full Text]
|
|
|
|
