Tirofiban in Stenting for Long Coronary Lesion

Safety and Efficacy of Peri-procedural Use of Tirofiban in Elective Percutaneous Coronary Intervention for Long Coronary Lesions With Overlapping Drug-Eluting Stent

Periprocedural myonecrosis or infarction are associated with short, intermediate, and long term adverse outcomes. Previous study indicated 12.6% of patients suffered a peri-procedural CK-MB rise by overlapping use of drug-eluting stents for long coronary lesions. Here the investigators hypothesize that peri-procedural use of tirofiban could reduce the occurrence of periprocedural infarciton in elective patients with long coronary lesions treated by overlapping use of drug-eluting stents.

According to the results of 12.6% occurrence of peri-procedural myocardial infarction after long stent implantation by previous report[International Journal of Cardiology 2009;134: 231-237], the investigator hypothesize the 50% reduction of peri-procedural MI by using tirofiban. Three hundred and sixty-nine patients in each group are needed to reach 80% of power with α 0.05.

Inclusion Criteria:

• Age between 18y~80y, with symptomatic coronary disease
• At least one lesion length more than 40mm to be treated by overlapping drug-eluting stents in major epicardial coronary vessel

Exclusion Criteria:

• Aspirin or clopidogrel intolerance
• Lesions length less than 40mm, or overlapping stent length less than 40mm
• Bifurcation lesions need to be treated by two stents
• Patients with acute coronary syndrome and elevated baseline cardiac enzyme (CK-MB)
• Left ventricular ejection fraction less than 0.35
• Baseline estimated GFR less than 30
• Estimated life time less than one year
• Refuse to sign the informed consent