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Prehospital tirofiban increases the rate of disrupted myocardial infarction in patients with ST-segment elevation myocardial infarction: insights from the On-TIME 2 trial

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-sensitivity cardiac troponin (hs-cTn) assays, is stil...

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Main Authors: Rikken, Sem A. O. F. (Author) , Fabris, Enrico (Author) , Rosenqvist, Tobias (Author) , Giannitsis, Evangelos (Author) , ten Berg, Jurriën M (Author) , Hamm, Christian (Author) , van ‘t Hof, Arnoud (Author)
Format: Article (Journal)
Language:English
Published: August 2024
In: European heart journal - acute cardiovascular care
Year: 2024, Volume: 13, Issue: 8, Pages: 595-601
ISSN:2048-8734
DOI:10.1093/ehjacc/zuae074
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1093/ehjacc/zuae074
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Author Notes:Sem A.O.F. Rikken, Enrico Fabris, Tobias Rosenqvist, Evangelos Giannitsis, Jurriën M. ten Berg, Christian Hamm, and Arnoud van ‘t Hof
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Summary: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-sensitivity cardiac troponin (hs-cTn) assays, is still unclear.The On-TIME 2 (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 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). 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 (odds ratio 2.03; 95% confidence interval 1.10-3.87; P = 0.027). None of the patients with disrupted MI died during the 1-year follow-up, compared with a mortality rate of 2.6% among those without disrupted MI.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 pre-treatment approaches that may increase the rate of disrupted MI.
Item Description:Veröffentlicht: 07 June 2024
Gesehen am 20.01.2025
Physical Description:Online Resource
ISSN:2048-8734
DOI:10.1093/ehjacc/zuae074

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