Effect of Early, Pre-Hospital Initiation of High Bolus Dose Tirofiban in Patients With ST-Segment Elevation Myocardial Infarction on Short- and Long-Term Clinical Outcome

Berg, Jürrien M. ten; Hof, Arnoud W J van ‘t; Dill, Thorsten; Heestermans, Ton; Werkum, Jochem W. van; Mosterd, Arend; Houwelingen, Gert van; Koopmans, Petra C.; Stella, Pieter R.; Boersma, Eric; Hamm, Christian W.

doi:10.1016/j.jacc.2009.11.091

Cited by 161 publications

(53 citation statements)

References 19 publications

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“…Analogues to our findings may be drawn to the experience with use of the glycoprotein IIb/IIIa inhibitor tirofiban for patients with STEMI, for which pretreatment with tirofiban may confer cardioprotective effects27 and improve clinical outcome 28. Notably, a post-hoc subanalysis demonstrated that the highest efficacy of tirofiban treatment was seen in patients with long healthcare system delays and tirofiban pretreatment time 29.…”

Section: Discussionsupporting

confidence: 70%

Remote ischaemic conditioning and healthcare system delay in patients with ST-segment elevation myocardial infarction

Pryds

Terkelsen

Sloth

et al. 2016

Heart

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Section: Discussionsupporting

confidence: 70%

Remote ischaemic conditioning and healthcare system delay in patients with ST-segment elevation myocardial infarction

Pryds

Terkelsen

Sloth

et al. 2016

Heart

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“…We have previously reported the long-term clinical outcomes benefit of a GPI-facilitated PCI strategy7; however, in this current analysis we provide further insight, showing that a high-risk subset of patients, as identified by higher levels of NT-proBNP upon presentation (figure 1), represents a subgroup who derives particular benefit from early GPI treatment in terms of significant mortality reduction up to 1 year (figure 2). This lower mortality rate was maintained up to 5 years, although at this point with a non-significant difference probably because other factors may influence very long-term outcomes.…”

Section: Discussionmentioning

confidence: 57%

Long-term mortality and prehospital tirofiban treatment in patients with ST elevation myocardial infarction

Fabris

Kılıç

Schellings

et al. 2017

Heart

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“…Similarly, in the Intracoronary Eptifibatide (ICE) Trial, the intracoronary bolus administration of eptifibatide during PCI in patients with acute coronary syndromes resulted in higher local platelet glycoprotein IIb/IIIa recept or occupancy, which was associated with improved microvascular perfusion demonstrated by an improved corrected TIMI Frame Count [9].…”

Section: Intracoronary Gp Iib/iiia Inhibitorsmentioning

confidence: 99%

Acute ST-Segment Elevation Myocardial Infarction: Combined Intracoronary Low Dose Eptifibatide and Thrombus Aspiration

Mahmoud¹

2014

WJCD

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Aim of the work: To evaluate the efficacy and safety of bolus only intra coronary platelet glycoprotein GP IIb/IIIa receptor antagonists combined with thrombus-aspiration during percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI). Patient and Methods: 25 consecutive STEMI patients treated by primary PCI including thrombus aspiration were prospectively enrolled, from a total of 180 PCIs performed at our institution between January 2013 and January 2014. All patients received aspirin (250 mg i.v.) and clopidogrel (600 or 300 mg if already on clopidogrel) plus standard heparin. Glycoprotein IIb/IIIa antagonists were administered at physicians' discretion before thrombus aspiration. Eptifibatide was used as a slandered Glycoprotein IIb/IIIa antagonists as a dose of the 180-μg/kg eptifibatide bolus only. The bolus was administered for 2 minutes via the thrombus aspiration catheter (STEMI cath of minvasys) just before thrombus aspiration. Twelve-lead ECGs were recorded at baseline and 60 min (45 -75 min) after completion of PCI. The primary endpoint was the TIMI 3 patency of the infarctrelated coronary artery before PCI. Secondary endpoints were TIMI patency following PCI, ST resolution 60 min after PCI, all-cause death, reinfarction, urgent revascularization, stroke (haemorrhagic, non-haemorrhagic), and severe bleeding complications. Results: The angiography was performed in all 25 patients. The incidence of a TIMI flow grade 3 of the infarct-related coronary artery before PCI was 16% while TIMI grade 2 and I was 24% and 36% respectively. The incidence of a TIMI flow grade 0 (no reflow) of the infarct-related coronary artery before PCI was 24%. Visible thrombus in 52% of patients and 40% of patients have more than one critically disease vessel. Primary PCI was performed in 25 patients. Eptifibatide intracoronary was given through thrombus aspiration catheter before thrombus aspiration. Drug eluting stents were implanted in 60% of patients. Only two patients with acute stent thrombosis did not receive any stents at PCI. One patient died 24 h after the procedure due to severe heart failure and cardiogenic shock. No reinfarction was noted within 30 days after the procedure. Generally heart failure improved significantly after the procedure and at the end of 30 day post operative. Only 3 patients had persistent heart S. E. Mahmoud 571 failure class III (12%). 84% of patients had TIMI flow III at the end of procedure with over all significant improvement. Significant TIMI flow improvement after procedure was noticed with P value, 001. Also the results showed significant shows of ST segment resolution after procedure. Conclusions: For patients with STEMI undergoing primary PCI, a routine combination of intracoronary administration of Eptifibatide before transcatheter thrombus aspiration is a safe procedure with low risk of hemorrhage and increases myocardial reperfusion, which ultimately improves outcomes. This therapeutic modality may be recommended for further improving ...

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Effect of Early, Pre-Hospital Initiation of High Bolus Dose Tirofiban in Patients With ST-Segment Elevation Myocardial Infarction on Short- and Long-Term Clinical Outcome

Abstract: Early, pre-hospital initiation of HBD tirofiban, in addition to high-dose clopidogrel, improves the clinical outcome after primary percutaneous coronary intervention in patients with STEMI. (Ongoing 2b/3a inhibition In Myocardial infarction Evaluation; ISRCTN06195297).

Cited by 161 publications

References 19 publications

Remote ischaemic conditioning and healthcare system delay in patients with ST-segment elevation myocardial infarction

Remote ischaemic conditioning and healthcare system delay in patients with ST-segment elevation myocardial infarction

Long-term mortality and prehospital tirofiban treatment in patients with ST elevation myocardial infarction

Acute ST-Segment Elevation Myocardial Infarction: Combined Intracoronary Low Dose Eptifibatide and Thrombus Aspiration

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