Tirofiban in Stenting for Long Coronary Lesion (PETITION)

• major bleeding [ Time Frame: during hospitalization (up to 2 weeks) ] [ Designated as safety issue: Yes ]
  The safety outcome of major bleeding according to the Thrombolysis in Myocardial Infarction (TIMI) definition
• major adverse cardiac event [ Time Frame: one year after procedure ] [ Designated as safety issue: No ]
  major adverse cardiac event (MACE) includes cardiac death, target vessel revascularization, and re-occurrence of myocardial infarction after discharge

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.

• Drug: tirofiban
  10μg/kg bolus followed by 0.15μg/kg/min maintenance infusion for 12h
  Other Name: Xinweining, Grand Pharmaceutical Group, Wuhan, China
• Drug: normal saline solution
  same use as tirofiban

• Placebo Comparator: Control group
  normal saline was applied to those randomized to control group, with same use as tirofiban
  Intervention: Drug: normal saline solution
• Experimental: Tirofiban group
  after angioram, and before guiding catheter engagement: 10μg/kg bolus followed by 0.15μg/kg/min maintenance infusion
  Intervention: Drug: tirofiban

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