1. Prehospital high-dose tirofiban in patients undergoing primary percutaneous intervention. The AGIR-2 study
- Author
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El Khoury, C., Dubien, P-Y., Belle, L., Debaty, G., Capel, O., Perret, T., Savary, D., Serre, P., Bonnefoy-Cudraz, E., Bissery, A., Ecochard, René, Plattner, V., Mercier, Catherine, Département biostatistiques et modélisation pour la santé et l'environnement [LBBE], Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), and Hospices Civils de Lyon (HCL)
- Subjects
Male ,Emergency Medical Services ,Time Factors ,medicine.medical_treatment ,[SDV]Life Sciences [q-bio] ,Inhibiteur du glycoprotéine IIb/IIIa ,Ambulances ,Myocardial Infarction ,Coronary Angiography ,Medicine ,Myocardial infarction ,Angioplasty, Balloon, Coronary ,Creatine Kinase ,ComputingMilieux_MISCELLANEOUS ,Angioplastie primaire ,General Medicine ,Tirofiban ,Clopidogrel ,Treatment Outcome ,Soins préhospitalier ,Anesthesia ,Platelet aggregation inhibitor ,Drug Therapy, Combination ,Female ,France ,Cardiology and Cardiovascular Medicine ,TIMI ,medicine.drug ,medicine.medical_specialty ,Ticlopidine ,Glycoprotein IIb/IIIa inhibitor ,Infarctus du myocarde ,Acute myocardial infarction ,Loading dose ,Prehospital care ,Drug Administration Schedule ,Angioplasty ,Coronary Circulation ,Humans ,Primary angioplasty ,business.industry ,Troponin I ,Percutaneous coronary intervention ,medicine.disease ,Surgery ,Tyrosine ,business ,Biomarkers ,Platelet Aggregation Inhibitors - Abstract
Summary Background Compared with administration in the catheterization laboratory, early treatment with glycoprotein IIb/IIIa inhibitors provides benefits to patients with ST-segment elevation myocardial infarction who undergo primary percutaneous intervention. Whether this benefit is maintained on top of a 600 mg loading dose of clopidogrel is unknown. Methods In a multicentre, controlled, randomized study, 320 patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention received a high-dose bolus of tirofiban given either in the ambulance (prehospital group) or in the catheterization laboratory. The primary endpoint was a TIMI flow grade 2–3 of the infarct-related vessel at initial angiography. Secondary endpoints included ST-segment resolution 1 h after percutaneous coronary intervention and peak serum troponin I concentration. Results Tirofiban was administered 48 (95% confidence interval 21.4–75.0) min earlier in the prehospital group. At initial angiography, the combined incidence of TIMI 2–3 flow was 39.7% in the catheterization-laboratory group and 44.2% in the prehospital group ( p = 0.45). No difference was found on postpercutaneous intervention angiography or peak troponin concentration. Complete ST-segment resolution 60 min after the start of intervention was 55.4% in the catheterization-laboratory group and 52.6% in the prehospital group ( p = 0.32). Conclusion Prehospital initiation of high-dose bolus tirofiban did not improve significantly initial TIMI 2 or 3 flow of the infarct-related artery or complete ST-segment resolution after coronary intervention compared with initiation of tirofiban in the catheterization laboratory ( NCT00538317 ).
- Published
- 2010
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