1. Marked reduction of early stent thrombosis with pre-hospital initiation of high-dose Tirofiban in ST-segment elevation myocardial infarction.
- Author
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Heestermans AA, Van Werkum JW, Hamm C, Dill T, Gosselink AT, De Boer MJ, Van Houwelingen G, Hoorntje JC, Koopmans PC, Ten Berg JM, and Van 't Hof AW
- Subjects
- Aged, Anticoagulants administration & dosage, Anticoagulants adverse effects, Anticoagulants therapeutic use, Aspirin administration & dosage, Aspirin adverse effects, Aspirin therapeutic use, Clopidogrel, Disease-Free Survival, Double-Blind Method, Drug Administration Schedule, Drug Therapy, Combination, Electrocardiography, Female, Fibrinolytic Agents administration & dosage, Fibrinolytic Agents adverse effects, Hemorrhage chemically induced, Hemorrhage epidemiology, Heparin administration & dosage, Heparin adverse effects, Heparin therapeutic use, Humans, Male, Middle Aged, Myocardial Infarction therapy, Platelet Aggregation Inhibitors administration & dosage, Platelet Aggregation Inhibitors adverse effects, Platelet Aggregation Inhibitors therapeutic use, Recurrence, Ticlopidine administration & dosage, Ticlopidine adverse effects, Ticlopidine analogs & derivatives, Ticlopidine therapeutic use, Tirofiban, Tyrosine administration & dosage, Tyrosine adverse effects, Tyrosine therapeutic use, Angioplasty, Balloon, Coronary, Coronary Thrombosis prevention & control, Emergency Medical Services methods, Emergency Medical Services statistics & numerical data, Fibrinolytic Agents therapeutic use, Myocardial Infarction drug therapy, Stents, Thrombolytic Therapy adverse effects, Tyrosine analogs & derivatives
- Abstract
Background: No randomized comparisons are yet available evaluating the effect of pre-hospital high dose tirofiban on the incidence of early stent thrombosis after primary percutaneous coronary intervention (PCI)., Objectives: The aim of this analysis was to evaluate whether routine pre-hospital administration of high-dose tirofiban in ST-segment elevation myocardial infarction (STEMI) decreases the incidence of early stent thrombosis after primary PCI., Patients/methods: The Ongoing Tirofiban in Myocardial Evaluation (On-TIME) 2 trial was a prospective multicenter study of consecutive STEMI patients referred for primary PCI in which patients were randomized to pre-hospital no high-dose tirofiban/placebo. We examined the incidence of Academic Research Consortium definite and probable early stent thrombosis and determined predictors and outcome of early stent thrombosis., Results: Primary PCI was performed in 1203 out of 1398 patients (86.1%). In 1073 patients (89.2%) a coronary stent was placed. Early stent thrombosis occurred in 39 patients (3.6%). Pre-hospital initiation of high-dose tirofiban significantly reduced early stent thrombosis (2.1% vs. 5.2%, P = 0.006) and was associated with a lower incidence of urgent repeat PCI (1.9% vs. 5.2%, P = 0.005). Early stent thrombosis, as well as pre-hospital initiation of high-dose tirofiban, was independently associated with 30-day mortality., Conclusions: Pre-hospital initiation of high-dose tirofiban reduces the 30-day incidence of stent thrombosis in STEMI patients treated with primary PCI and stenting. Early stent thrombosis and pre-hospital initiation of high-dose tirofiban were independent predictors of 30-day mortality.
- Published
- 2009
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