Glycoprotein IIb/IIIa inhibitors in acute myocardial infarction and angiographic microvascular obstruction: the REVERSE-FLOW trial.

Autor:	Eitel I; Medical Clinic II, University Heart Center Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany., Saraei R; Medical Clinic II, University Heart Center Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany., Jurczyk D; Medical Clinic II, University Heart Center Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany., Fach A; Bremen Institute for Heart and Circulation Research (BIHKF), Senator-Weßling-Straße, 228277 Bremen, Germany., Hambrecht R; Bremen Institute for Heart and Circulation Research (BIHKF), Senator-Weßling-Straße, 228277 Bremen, Germany., Wienbergen H; Bremen Institute for Heart and Circulation Research (BIHKF), Senator-Weßling-Straße, 228277 Bremen, Germany., Frerker C; Medical Clinic II, University Heart Center Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany., Schmidt T; Medical Clinic II, University Heart Center Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany., Allali A; Medical Clinic II, University Heart Center Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany., Joost A; Medical Clinic II, University Heart Center Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany., Marquetand C; Medical Clinic II, University Heart Center Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany., Kurz T; Medical Clinic II, University Heart Center Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany., Haaf P; Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland., Fahrni G; Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland., Mueller C; Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland., Desch S; Department of Internal Medicine/Cardiology and Leipzig Heart Science, Heart Center Leipzig at University of Leipzig, Leipzig, Germany., Thiele H; Department of Internal Medicine/Cardiology and Leipzig Heart Science, Heart Center Leipzig at University of Leipzig, Leipzig, Germany., Stiermaier T; Medical Clinic II, University Heart Center Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
Jazyk:	angličtina
Zdroj:	European heart journal [Eur Heart J] 2024 Dec 16; Vol. 45 (47), pp. 5058-5067.
DOI:	10.1093/eurheartj/ehae587
Abstrakt:	Background and Aims: Glycoprotein (GP) IIb/IIIa inhibitors are recommended in acute myocardial infarction (AMI) for bailout treatment in case of angiographic microvascular obstruction (MVO), also termed no-reflow phenomenon, after percutaneous coronary intervention (PCI) with, however, lacking evidence (class IIa, level C). Methods: The investigator-initiated, international, multicentre REVERSE-FLOW trial randomized 120 patients with AMI and thrombolysis in myocardial infarction flow grade ≤ 2 after primary PCI to optimal medical therapy with or without GP IIb/IIIa inhibitor. The primary endpoint was infarct size [percentage of left ventricular (LV) mass assessed by cardiac magnetic resonance (CMR). Secondary endpoints included CMR-derived MVO and 30-day adverse clinical events. The trial is registered with ClinicalTrials.gov: NCT02739711. Results: The population was predominantly male (76.7%) with a median age of 66 years and ST-elevation myocardial infarction in 73.3% of patients. Clinical and angiographic characteristics were well balanced between the cohorts. Patients in the treatment group (n = 62) received eptifibatide (n = 41) or tirofiban (n = 21). Infarct size assessed by CMR imaging was similar in both study groups [25.4% of LV mass (%LV) vs. 25.2%LV; P = .386]. However, the number of patients with evidence of CMR-derived MVO (74.5% vs. 92.2%; P = .017) and the extent of MVO (2.1%LV vs. 3.4%LV; P = .025) were significantly reduced in the GP IIb/IIIa inhibitor group compared with controls. Thirty-day outcome showed an increased bleeding risk after GP IIb/IIIa inhibitor administration restricted to non-life-threatening bleedings (22.6% vs. 6.9%; P = .016) without differences in all-cause mortality (4.8% vs. 3.4%; P = .703). Conclusions: Bailout GP IIb/IIIa inhibition in AMI patients with angiographic MVO failed to reduce the primary endpoint infarct size but decreased CMR-derived MVO and led to an increase in non-fatal bleeding events. (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
Databáze:	MEDLINE
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