Prehospital tirofiban increases the rate of disrupted myocardial infarction in patients with ST-segment elevation myocardial infarction: insights from the On-TIME 2 trial.

Autor:	Rikken SAOF; Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.; Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands., Fabris E; Cardiothoracovascular Department, University of Trieste, Trieste, Italy., Rosenqvist T; Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.; Department of Cardiology, Zuyderland Medical Center, Heerlen, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands., Giannitsis E; Department of Cardiology, Universitaetsklinik, Heidelberg, Germany., Ten Berg JM; Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.; Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.; Department of Cardiology, Maastricht University Medical Center, P. Debyelaan 25 | 6229 HX Maastricht, Locatie: MUMC+, Level 3, Postbus 5800 | 6202 AZ Maastricht, The Netherlands., Hamm C; Department of Cardiology, Kerckhoff Klinik, Bad Nauheim, Germany., van 't Hof A; Department of Cardiology, Zuyderland Medical Center, Heerlen, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands.; Department of Cardiology, Maastricht University Medical Center, P. Debyelaan 25 | 6229 HX Maastricht, Locatie: MUMC+, Level 3, Postbus 5800 | 6202 AZ Maastricht, The Netherlands.
Jazyk:	angličtina
Zdroj:	European heart journal. Acute cardiovascular care [Eur Heart J Acute Cardiovasc Care] 2024 Aug 28; Vol. 13 (8), pp. 595-601.
DOI:	10.1093/ehjacc/zuae074
Abstrakt:	Aims: In patients with ST-segment elevation myocardial infarction (STEMI), prehospital tirofiban significantly improved myocardial reperfusion. However, its impact on the rate of disrupted myocardial infarction (MI), particularly in the context of high-sensitivity cardiac troponin (hs-cTn) assays, is still unclear. Methods and Results: The On-TIME 2 (Ongoing Tirofiban In Myocardial infarction Evaluation 2) trial randomly assigned STEMI patients to prehospital tirofiban or placebo before transportation to a percutaneous coronary intervention (PCI) centre. In this post hoc analysis, we evaluated STEMI patients that underwent primary PCI and had measured hs-cTn levels. Troponin T levels were collected at 18-24 and 72-96 h after PCI. Disrupted MI was defined as peak hs-cTn T levels ≤ 10 times the upper limit of normal (≤140 ng/L). Out of 786 STEMI patients, 47 (6%) had a disrupted MI. Disrupted MI occurred in 31 of 386 patients (8.0%) in the tirofiban arm and in 16 of 400 patients (4.0%) in the placebo arm (P = 0.026). After multivariate adjustment, prehospital tirofiban remained independently associated with disrupted MI (odds ratio 2.03; 95% confidence interval 1.10-3.87; P = 0.027). None of the patients with disrupted MI died during the 1-year follow-up, compared with a mortality rate of 2.6% among those without disrupted MI. Conclusion: Among STEMI patients undergoing primary PCI, the use of prehospital tirofiban was independently associated with a higher rate of disrupted MI. These results, highlighting a potential benefit, underscore the need for future research focusing on innovative pre-treatment approaches that may increase the rate of disrupted MI. Competing Interests: Conflict of interest: S.A.O.F.R. reports speaker fees from Daiichi Sankyo. E.F., T.R., and E.G. have nothing to report. J.M.t.B. reports speaker fees from AstraZeneca, Daiichi Sankyo, Eli Lilly, The Medicines Company, Accumetrics, Boehringer Ingelheim, Bayer, BMS, Pfizer, and Ferrer. J.M.t.B. serves as a scientific advisor to CeleCor. C.H. has nothing to report. A.W.J.v.H. reports unrestricted grants from AstraZeneca, Medtronic, Boehringer Ingelheim, Abbott Vascular, and Ferrer. A.W.J.v.H. serves as a scientific advisor to CeleCor. (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Databáze:	MEDLINE
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