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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• 作者：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 Z
• 关键词：Reperfusion ; Primary PCI ; STEMI ; Glycoprotein IIb/IIIa receptor inhibitors
• 刊名：Journal of Electrocardiology
• 出版年：2011
• 出版时间：January-February 2011
• 年：2011
• 卷：44
• 期：1
• 页码：42-48
• 全文大小：327 K

文摘

class=""h4"">Objective

The 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.

class=""h4"">Methods

Patients 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.

class=""h4"">Results

Complete 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.

class=""h4"">Conclusions

Dual 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.