Tirofiban usage and prognosis after myocardial infarction.

To the Editor,

I read the article by Kaymaz et al. (1), entitled “The effects of tirofiban infusion on clinical and angiographic outcomes of patients with STEMI undergoing primary PCI.” which was recently published online in your journal, with great interest. In their study, the authors reported that additional tirofiban usage significantly improves myocardial reperfusion, ST-segment resolution, in-hospital mortality rate, and in-hospital sudden cardiac death in patients with ST-segment elevation myocardial infarction (STEMI). I would like to make a critique on the methodology and results of the present study.

Tirofiban usage may be beneficial in patients with STEMI, but its effect on mortality is unclear. In the present study by Kaymaz et al. (1), there are no data about medications that are known to significantly reduce mortality and cardiovascular events in patients with STEMI. It is well known that statins, angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin-receptor blockers (ARBs), and beta-blockers significantly reduce in-hospital and long-term mortalities and cardiovascular events in patients with STEMI (2). Also, Kaymaz et al. (1) did not report any data on the left ventricular ejection fraction for the patient groups. A low left ventricular ejection fraction is a strong predictor of mortality after myocardial infarction, and it is a predictor of in-hospital mortality in patients with STEMI who underwent primary percutaneous coronary intervention (3, 4). Additionally, aldosterone receptor antagonists significantly reduce mortality in post-myocardial infarction patients with left ventricle dysfunction (5). Therefore, lower medication rates with statins, ACEIs/ARBs, aldosterone antagonists, and beta-blockers and a lower ejection fraction in the non-tirofiban group may be another reason for higher mortality rates and cardiac events. The authors should state the mean ejection fraction and medications for each group and should compare the groups based on their medications and ejection fraction.

In conclusion, tirofiban usage may have beneficial effects in addition to standard therapy in patients with STEMI. However, to define its exact role on mortality, ejection fraction and medications that are known to reduce mortality should be taken into consideration.