Conflict of interest: Arnoud van 't Hof has received speaker fees from Merck, Sanofi Aventis, and Schering Plough. Christian Hamm has received advisory board/speaker fees from Merck, Iroko, Lilly, GlaxoSmithKline, Sanofi Aventis, the Medicines Company, Roche, and Abbott. Jurrien ten Berg has received speakers fees from Sanofi-Aventis, Eli Lilly, BMS, and MSD; and consults for Sanofi-Aventis, Eli Lilly, Schering-plough, and GlaxoSmithKline. Wouter van Werkum has received advisory board/speakers fees from The Medicines Company, Siemens, and Accumetrics. All other authors declare that they have no conflict of interest.
Coronary Artery Disease
The effect of pre-hospital glycoprotein IIb–IIIa inhibitors on angiographic outcome in STEMI patients who are candidates for primary PCI†
Version of Record online: 12 DEC 2011
Copyright © 2011 Wiley Periodicals, Inc.
Catheterization and Cardiovascular Interventions
Volume 79, Issue 6, pages 956–964, 1 May 2012
How to Cite
Hermanides, R. S., van Werkum, J. W., Ottervanger, J. P., Breet, N. J., Gosselink, A.T. M., van Houwelingen, K. G., Dambrink, J.-H. E., Hamm, C., ten Berg, J. M., van 't Hof, A. W.J. and On behalf of the Ongoing Tirofiban In Myocardial infarction Evaluation (On-TIME) 2 study group (2012), The effect of pre-hospital glycoprotein IIb–IIIa inhibitors on angiographic outcome in STEMI patients who are candidates for primary PCI. Cathet. Cardiovasc. Intervent., 79: 956–964. doi: 10.1002/ccd.23165
- Issue online: 17 APR 2012
- Version of Record online: 12 DEC 2011
- Manuscript Accepted: 19 MAR 2011
- Manuscript Revised: 10 MAR 2011
- Manuscript Received: 27 JAN 2011
- Merck and Co.
- corrected TIMI frame count;
- glycoprotein IIb/IIIa inhibitors;
- high bolus dose tirofiban;
- thrombus burden;
- primary percutaneous coronary intervention;
- ST-segment elevation myocardial infarction
Objectives: Aim of this study was to assess the effect of early initiation of high bolus dose tirofiban on top of dual antiplatelet therapy on angiographic outcome before and after primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infraction patients. Background: Glycoprotein IIb/IIIa inhibitors are effective inhibitors of platelet aggregation, and have shown to reduce thrombotic complications in patients undergoing PCI. Methods: This is a pre-specified angiographic analysis of the On-TIME 2 trial (N = 984) and its open label run-in phase (N = 414). All angiographic parameters, including quantitative coronary angiography (QCA) were performed in an independent angiographic core lab. Results: Of the 1,398 patients, 709 patients (50.7%) were randomized to pre-hospital tirofiban. An open infarct related vessel (TIMI 2 or 3 flow) at initial angiography was more often present in the tirofiban group as compared to the no tirofiban group (58.3% vs. 49.7%, P = 0.002). Tirofiban also reduced initial thrombus burden (P for trend = 0.035) as well as thrombus grade 5 (46.9% vs. 54.3%, P = 0.016) and showed a trend toward a reduction in large thrombus burden (LTB) (69.4% vs. 74.5%, P = 0.055). After PCI, a trend towards a lower corrected TIMI frame count (cTFC) in the tirofiban group was found. A significant interaction was found with time of initiation of study drug, with highest efficacy of tirofiban when given within 76 min after symptom onset, with a significantly lower cTFC after PCI (21.9 ± 17.6 vs. 23.9 ± 18.5, P = 0.008, P for interaction P = 0.006). Conclusion: In patients undergoing primary PCI, pre-hospital administration of tirofiban reduces initial thrombus burden and improves initial patency of the infarct related vessel before PCI. Initiation of tirofiban seems to be most effective when given very early after the onset of symptoms; however, this finding needs confirmation in other studies. Clinical trial registration: The On-TIME 2 trial is registered, at http://isrctn.org, number ISRCTN06195297. © 2011 Wiley Periodicals, Inc.