Effect of early tirofiban administration on N‐terminal pro‐B‐type natriuretic peptide level in patients treated with primary percutaneous coronary intervention

Abstract

Objectives To investigate the potential association between early tirofiban treatment and N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) level after primary percutaneous coronary intervention (PCI). Background Whether the use of adjunctive early glycoprotein IIb/IIIa inhibitors (GPIs) therapy, may affect the level of NT‐proBNP after primary PCI is poorly studied. Methods Nine hundred and eighty four ST‐elevation myocardial infarction (STEMI) patients undergoing primary PCI were randomized to either pre‐hospital tirofiban administration or placebo. NT‐proBNP levels were evaluated on admission before angiography (baseline) and 18–96 hr after PCI. Results There were 918 (93.3%) patients with NT‐proBNP values available at baseline and 865 (87.9%) post‐PCI. Post‐PCI NT‐proBNP level dichotomized with median value as cut‐off (968.8 pg/mL, IQR 430.9–1970.0) was significantly lower in patients treated with early tirofiban as compared to placebo (45.5% vs. 54.2% P = 0.011). At multivariate logistic regression analysis, independent predictors of post‐PCI NT‐proBNP level above the median were: NT‐proBNP baseline level (OR 5.19; 95% CI, 2.92–9.25, P < 0.001), Killip class>I (OR 4.07; 95% CI 1.24–13.36, P = 0.021), anterior infarct location (OR 2.61; 95% CI 1.84–3.70, P < 0.001), age (years) (OR 1.04; 95% CI 1.03–1.06, P < 0.001), male gender (OR 0.38; 95% CI 0.26–0.57, P < 0.001), prior PCI (OR 0.49; 95% CI 0.27–0.90, P = 0.021) and tirofiban administration (OR 0.71; 95% CI 0.51–0.99; P = 0.045). Conclusions In a large cohort of STEMI patients, pre‐hospital tirofiban administration was independently associate with a lower risk of high NT‐proBNP level after primary PCI, supporting the potential benefit of early antithrombotic treatment administration in STEMI patients. The trial is registered under No. ISRCTN06195297.

Efficacy and safety of glycoprotein IIb/IIIa inhibitors in addition to P2Y12 inhibitors in ST‐segment elevation myocardial infarction: A subanalysis of the POPular Genetics trial

“…However, the ON‐TIME 2 trial showed beneficial effects of routine upfront GPI administration in the ambulance in addition to clopidogrel on angiographic and ischemic events 5,21,22 . GPI use was also associated with lower N‐terminal prohormone of brain natriuretic peptide (NT‐proBNP levels) 23 . In STEMI patients with high levels of NT‐proBNP, GPI use was associated with a reduction in mortality up to 5 years 24 .…”

Pre-Hospital Antiplatelet Therapy for STEMI Patients Undergoing Primary Percutaneous Coronary Intervention: What We Know and What Lies Ahead

“…78 Exploratory analyses also showed improvement in initial thrombus burden and initial patency of the infarct-related vessel among patients who were administered tirofiban compared with placebo, 79 and prehospital tirofiban administration was independently associated with a lower risk of high N-terminal pro-brain natriuretic peptide (NT-proBNP) level after primary PCI. 80 In the last years, the use of GPI has declined, mainly due to the perception that the ischaemic benefits are counterbalanced by bleeding risks; however, clinical data on GPI bleeding risk may overstate the current experience since it is mainly based on earlier studies that included prolonged post-bolus drug infusion and femoral access site instrumentation. Thus, a high-risk subset of patients may derive particular benefit from early tirofiban treatment in terms of reduced short-and long-term mortality, without a significant increase in bleeding complications.…”