Long-term mortality and prehospital tirofiban treatment in patients with ST elevation myocardial infarction
Objective We undertook a subgroup analysis of the On-TIME 2 (Ongoing Tirofiban In Myocardial infarction Evaluation 2), a placebo-controlled, double-blind, randomised trial, in order to evaluate the association between N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and long-term (5 year...
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| Main Authors: | , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
September 11, 2017
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| In: |
Heart
Year: 2017, Volume: 103, Issue: 19, Pages: 1515-1520 |
| ISSN: | 1468-201X |
| DOI: | 10.1136/heartjnl-2017-311181 |
| Online Access: | Verlag, Volltext: http://dx.doi.org/10.1136/heartjnl-2017-311181 Verlag, Volltext: https://heart.bmj.com/content/103/19/1515 
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| Author Notes: | Enrico Fabris, Sinem Kilic, Dirk A.A.M. Schellings, Jurrien M. ten Berg, Mark W. Kennedy, K. Gerts van Houwelingen, Evangelos Giannitsis, Evelien Kolkman, Jan Paul Ottervanger, Christian Hamm, Arnoud W.J. van’t Hof |
| Summary: | Objective We undertook a subgroup analysis of the On-TIME 2 (Ongoing Tirofiban In Myocardial infarction Evaluation 2), a placebo-controlled, double-blind, randomised trial, in order to evaluate the association between N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and long-term (5 years) mortality and to investigate the effect of prehospital tirofiban administration on mortality in relation to NT-proBNP levels. Methods; A total of 984 patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) were randomised to either in ambulance tirofiban or placebo. NT-proBNP levels were evaluated on admission before angiography (baseline) and 18-96 hours thereafter (post PCI). Results: There were 918 (93.3%) patients with NT-proBNP values available at baseline and 865 (87.9%) post PCI. Patients with baseline NT-proBNP values above the median (137 pg/mL) had higher 30-day (5.1% vs 0.2%, p<0.001), 1-year (7.0% vs 0.7%, p<0.001) and 5-year (20.3% vs 4.9%, p<0.001) mortality as compared with patients with values below the median. Using multivariate Cox analysis, NT-proBNP above the median was an independent predictor for 5-year mortality (HR 2.73, 95% CI 1.47 to 5.06; p=0.002). Patients with values above the median who received early tirofiban treatment had significant lower mortality compared with patients treated with placebo at 30 days (2.7% vs 7.5%, p=0.021) and 1 year (4.5% vs 9.4%, p=0.043). At 5 years, a lower but non-significant mortality rate was maintained in the treatment group (18% vs 22.4%, p=0.265). Conclusions: In patients with STEMI, baseline NT-proBNP level independently predicts long-term mortality. In patients with baseline NT-proBNP levels above the median, early prehospital treatment with tirofiban significantly reduced 30-day and 1-year mortality, suggesting that high-risk patients may derive particular benefit. This finding should be confirmed in other studies. Trial registration number ISRCTN06195297. |
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| Item Description: | Gesehen am 12.11.2018 |
| Physical Description: | Online Resource |
| ISSN: | 1468-201X |
| DOI: | 10.1136/heartjnl-2017-311181 |