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)

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J Am Coll Cardiol, 2002; 40:662-668
© 2002 by the American College of Cardiology Foundation

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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 WithoutAdministration of the Glycoprotein IIb/IIIa Receptor AntagonistTirofiban (TOPSTAR) trial investigated: 1) the amount of troponinT (TnT) release after nonacute, elective percutaneous coronaryintervention (PCI) in patients pretreated with aspirin and clopidogrel;and 2) the effect of additional glycoprotein (GP) IIb/IIIa receptorinhibiton on postinterventional TnT release.

BACKGROUND: No data are available yet as to whether additional administrationof a GP IIb/IIIa receptor antagonist might be beneficial inpatients undergoing elective PCI already pretreated with aspirinand clopidogrel.

METHODS: After bolus application of the study medication (tirofiban [T]or placebo [P]), PCI was performed followed by an 18-h continuousinfusion of T/P. Primary end point of the study was incidenceand 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 receivingT (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 thepatients. No differences were observed regarding major bleeding,intracranial bleeding or nonhemorrhagic strokes. After ninemonths a reduction of combined death/myocardial infarction/targetvessel revascularization could be observed in the tirofibangroup ([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 afterpretreatment with aspirin and clopidogrel. The GP IIb/IIIa receptorantagonist tirofiban is able to decrease the incidence of troponinrelease 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

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