Facilitated reperfusion with prehospital glycoprotein IIb/IIIa inhibition: predictors of complete ST-segment resolution before primary percutaneous coronary intervention in the On-TIME 2 trial: Correlates of reperfusion before primary PCI |
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| Authors: | Ton Heestermans,Harry Suryapranata,Jurrië n M. ten Berg,Arend Mosterd,A.T. Marcel Gosselink,Waclav Kochman,Thorsten Dill,Gert van Houwelingen,Evelien Kolkman,Jochem W. van Werkum,Felix Zijlstra,Christian Hamm,Arnoud W.J. van 't Hof |
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| Affiliation: | a Department of Cardiology, Medisch Centrum Alkmaar, Alkmaar, The Netherlandsb Department of Cardiology, Isala Klinieken, Zwolle, The Netherlandsc Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlandsd Department of Cardiology, Meander Medisch Centrum, Amersfoort, The Netherlandse Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlandsf Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlandsg Department of Cardiology, Swissmed Centrum, Zdrowia S.A., Polandh Department of Cardiology, Kerckhoff-Klinik GmbH, Bad Nauheim, Germanyi Department of Cardiology, Medisch Spectrum Twente, Enschede, The Netherlandsj Department of Medical Statistics, Diagram BV, Zwolle, The Netherlandsk Department of Cardiology, Universitair Medisch Centrum, Groningen, The Netherlands |
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| Abstract: | ObjectiveThe objective of this study is to evaluate the incidence, predictors, and outcome of complete ST-segment resolution (STR) during transportation after pretreatment with dual or triple antiplatelet therapy in the Ongoing Tirofiban in Myocardial Infarction Evaluation (On-TIME) 2 trial.MethodsPatients with ST-segment elevation myocardial infarction were randomized in the ambulance to pretreatment with high-dose tirofiban (HDT) or to a control pretreatment (placebo or no HDT) on top of 600-mg clopidogrel, 500-mg aspirin, and 5000-IU unfractionated heparin. Complete STR was defined as ≥70% STR on the electrocardiogram obtained before percutaneous coronary intervention (PCI) as compared with the inclusion electrocardiogram.ResultsComplete STR before PCI occurred in 16.8% (n = 188/1121) and more frequently in the HDT group (19.0% vs 14.6%, P = .05). Independent predictors for complete STR before PCI were younger age (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.70-0.96, P = .01 per 10 year increase), fast diagnosis (OR, 0.97; 95% CI, 0.97-1.0, P = .004 per 15-minute increase time from symptom onset to diagnosis), longer pretreatment time (OR, 1.09; 95% CI, 1.03-1.16, P = .003 per 15-minute increase time start study medication to angiography), and randomization to HDT (OR, 1.39; 95% CI, 1.0-1.9, P = .05). Complete STR before PCI was associated with very low 30-day (0.5% vs 2.8%, P = .07) and 1-year (1.1% vs 5.0%, P = .019) mortality.ConclusionsDual or triple antiplatelet pretreatment in the ambulance results in complete STR before PCI in 17% of patients. Fast ST-segment elevation myocardial infarction diagnosis, prehospital initiation of pretreatment early after symptom onset, and HDT independently predicted STR before PCI. Complete STR is associated with improved clinical outcome. |
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| Keywords: | Reperfusion Primary PCI STEMI Glycoprotein IIb/IIIa receptor inhibitors |
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