BACKGROUND: The Multicentre Evaluation of Single high-dose Bolus TiRofiban versus Abciximab with Sirolimus-eluting Stent or Bare Metal Stent in Acute Myocardial Infarction Study [MULTISTRATEGY]) randomised 745 patients with ST-elevation myocardial infarction to receive high-dose bolus (HDB) tirofiban or abciximab infusion and sirolimus-eluting (SES) or uncoated-stent (BMS) implantation. Tirofiban was non-inferior to abciximab in terms of ST-segment resolution after intervention, whereas 8 month-major adverse cardiac events occurred in 14.5\% in the BMS and 7.8\% in the SES groups (P=0.0039), reflecting a reduction of reintervention rates (10.2\% vs. 3.2\%). A three-year follow-up was performed to extend previous short- to mid-term findings. METHODS AND RESULTS: Complete data at 3years was available for 736 patients (99\%). All-cause mortality was 6.7\% in the tirofiban and 7.8\% in the abciximab (P=0.56) and 7.5\% in the BMS vs 7.0 in the SES groups, P=0.79. The composite of all-cause death or MI was identical at 12.9\% in tirofiban and abciximab groups, P=0.99 and it occurred in 13.2\% in the BMS vs. 12.6\% in the SES groups (P=0.83). The need for reintervention remained more than twice as common with BMS (13.7\%; versus 6.2\%, P=0.0006). The cumulative rate of stent thrombosis (ST) did not differ. This is inspite of a higher very late definite, probable or possible ST thrombosis rate in the SES group. CONCLUSIONS: The 3-year follow-up of MULTISTRATEGY demonstrated comparable outcomes with HDB Tirofiban or abciximab and a sustained efficacy of SES to reduce reintervention with no difference in death, repeat MI or ST.
Three-year follow-up of the MULTIcentre evaluation of Single high-dose Bolus TiRofiban versus Abciximab with Sirolimus-eluting STEnt or Bare-Metal Stent in Acute Myocardial Infarction StudY (MULTISTRATEGY).
RIBICHINI, Flavio Luciano;VASSANELLI, Corrado;
2011-01-01
Abstract
BACKGROUND: The Multicentre Evaluation of Single high-dose Bolus TiRofiban versus Abciximab with Sirolimus-eluting Stent or Bare Metal Stent in Acute Myocardial Infarction Study [MULTISTRATEGY]) randomised 745 patients with ST-elevation myocardial infarction to receive high-dose bolus (HDB) tirofiban or abciximab infusion and sirolimus-eluting (SES) or uncoated-stent (BMS) implantation. Tirofiban was non-inferior to abciximab in terms of ST-segment resolution after intervention, whereas 8 month-major adverse cardiac events occurred in 14.5\% in the BMS and 7.8\% in the SES groups (P=0.0039), reflecting a reduction of reintervention rates (10.2\% vs. 3.2\%). A three-year follow-up was performed to extend previous short- to mid-term findings. METHODS AND RESULTS: Complete data at 3years was available for 736 patients (99\%). All-cause mortality was 6.7\% in the tirofiban and 7.8\% in the abciximab (P=0.56) and 7.5\% in the BMS vs 7.0 in the SES groups, P=0.79. The composite of all-cause death or MI was identical at 12.9\% in tirofiban and abciximab groups, P=0.99 and it occurred in 13.2\% in the BMS vs. 12.6\% in the SES groups (P=0.83). The need for reintervention remained more than twice as common with BMS (13.7\%; versus 6.2\%, P=0.0006). The cumulative rate of stent thrombosis (ST) did not differ. This is inspite of a higher very late definite, probable or possible ST thrombosis rate in the SES group. CONCLUSIONS: The 3-year follow-up of MULTISTRATEGY demonstrated comparable outcomes with HDB Tirofiban or abciximab and a sustained efficacy of SES to reduce reintervention with no difference in death, repeat MI or ST.
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