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, Sem A O F Rikken Department of Cardiology, St. Antonius Hospital , Nieuwegein , the Netherlands Cardiovascular Research Institute Maastricht , Maastricht , the Netherlands Search for other works by this author on: Oxford Academic Enrico Fabris Cardiothoracovascular Department, University of Trieste , Trieste , Italy Search for other works by this author on: Oxford Academic Tobias Rosenqvist Cardiovascular Research Institute Maastricht , Maastricht , the Netherlands Department of Cardiology, Zuyderland Medical Center , Heerlen , the Netherlands Search for other works by this author on: Oxford Academic Evangelos Giannitsis Department of Cardiology, Universitaetsklinik , Heidelberg , Germany Search for other works by this author on: Oxford Academic Jurriën M ten Berg Department of Cardiology, St. Antonius Hospital , Nieuwegein , the Netherlands Cardiovascular Research Institute Maastricht , Maastricht , the Netherlands Department of Cardiology, Maastricht University Medical Center , Maastricht , the Netherlands Search for other works by this author on: Oxford Academic Christian Hamm Department of Cardiology, Kerckhoff Klinik , Bad Nauheim , Germany Search for other works by this author on: Oxford Academic Arnoud W J van’t Hof Department of Cardiology, Zuyderland Medical Center , Heerlen , the Netherlands Department of Cardiology, Maastricht University Medical Center , Maastricht , the Netherlands Address for correspondence: Professor Arnoud W.J. van ‘t Hof, MD, PhD, Head of the department of Interventional Cardiology in Maastricht University Medical Center and Zuyderland Medical Center in Heerlen, the Netherlands, P. Debyelaan 25 | 6229 HX Maastricht, Locatie: MUMC+, level 3, Postbus 5800 | 6202 AZ Maastricht, E arnoud.vant.hof@mumc.nl, T +31(0)43-3875087 | M + 31(6)50635162 Search for other works by this author on: Oxford Academic
European Heart Journal. Acute Cardiovascular Care, zuae074, https://doi.org/10.1093/ehjacc/zuae074
Published:
07 June 2024
Article history
Received:
13 March 2024
Revision received:
30 May 2024
Accepted:
05 June 2024
Published:
07 June 2024
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Sem A O F Rikken, Enrico Fabris, Tobias Rosenqvist, Evangelos Giannitsis, Jurriën M ten Berg, Christian Hamm, Arnoud W J van’t Hof, Prehospital Tirofiban Increases the Rate of Disrupted Myocardial Infarction in Patients with ST-Segment Elevation Myocardial Infarction: Insights From the On-TIME 2 Trial, European Heart Journal. Acute Cardiovascular Care, 2024;, zuae074, https://doi.org/10.1093/ehjacc/zuae074
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Abstract
Background
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-sensitive cardiac troponin (hs-cTn) assays, is still unclear.
Methods
The On-TIME 2 (The 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 h 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).
Results
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 (OR 2.03; 95% CI 1.10 to 3.87; P= 0.027). None of the patients with disrupted MI died during the one-year follow-up, compared to 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 pretreatment approaches which may increase the rate of disrupted MI.
Graphical Abstract
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STEMI, tirofiban, prehospital, glyocprotein IIb/IIIa inhibitors, disrupted myocardial infarction
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© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. 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.
Topic:
- myocardial infarction
- tirofiban
- st segment elevation myocardial infarction
- on-time 2 trial
Issue Section:
Original Scientific Paper
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