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Heestermans AA, Hermanides RS, Gosselink AT, et al. A comparison between upfront high-dose tirofiban versus provisional use in the real-world of non-selected STEMI patients undergoing primary PCI: Insights from the Zwolle acute myocardial infarction registry. Neth Heart J. 2010;18(12):592-7doi: 10.1007/s12471-010-0840-z.
Heestermans, A. A., Hermanides, R. S., Gosselink, A. T., de Boer, M. J., Hoorntje, J. C., Suryapranata, H., Ottervanger, J. P., Dambrink, J. H., Kolkman, E., Ten Berg, J. M., Zijlstra, F., & van 't Hof, A. W. (2010). A comparison between upfront high-dose tirofiban versus provisional use in the real-world of non-selected STEMI patients undergoing primary PCI: Insights from the Zwolle acute myocardial infarction registry. Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation, 18(12), 592-7. https://doi.org/10.1007/s12471-010-0840-z
Heestermans, A A C M, et al. "A comparison between upfront high-dose tirofiban versus provisional use in the real-world of non-selected STEMI patients undergoing primary PCI: Insights from the Zwolle acute myocardial infarction registry." Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation vol. 18,12 (2010): 592-7. doi: https://doi.org/10.1007/s12471-010-0840-z
Heestermans AA, Hermanides RS, Gosselink AT, de Boer MJ, Hoorntje JC, Suryapranata H, Ottervanger JP, Dambrink JH, Kolkman E, Ten Berg JM, Zijlstra F, van 't Hof AW. A comparison between upfront high-dose tirofiban versus provisional use in the real-world of non-selected STEMI patients undergoing primary PCI: Insights from the Zwolle acute myocardial infarction registry. Neth Heart J. 2010 Dec;18(12):592-7. doi: 10.1007/s12471-010-0840-z. PMID: 21301621; PMCID: PMC3018604.
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Neth Heart J. 2010 Dec;18(12):592-7. doi: 10.1007/s12471-010-0840-z.

A comparison between upfront high-dose tirofiban versus provisional use in the real-world of non-selected STEMI patients undergoing primary PCI: Insights from the Zwolle acute myocardial infarction registry.

Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation

A A C M Heestermans, R S Hermanides, A T M Gosselink, M J de Boer, J C A Hoorntje, H Suryapranata, J P Ottervanger, J-H E Dambrink, E Kolkman, J M Ten Berg, F Zijlstra, A W J van 't Hof

Affiliations

  1. Department of Cardiology, Medical Centre Alkmaar, Alkmaar, the Netherlands.

PMID: 21301621 PMCID: PMC3018604 DOI: 10.1007/s12471-010-0840-z

Abstract

BACKGROUND: Despite the proven benefit of glycoprotein IIb/IIIa blockers in patients with acute ST-segment elevation myocardial infarction (STEMI), there is still debate on the timing of administration of these drugs and whether all or only a selection of patients should be treated. We evaluated the effect of routine upfront versus provisional use of high-dose tirofiban (HDT) in a large real-world population of non-selected STEMI patients.

METHODS: Consecutive STEMI patients were registered in a single-centre dedicated database. Patients with upfront HDT therapy before first balloon inflation were compared with patients who received the drug on a provisional basis, after first balloon inflation. Initial TIMI flow of the infarct-related vessel and enzymatic infarct size and 30-day clinical outcome were assessed.

RESULTS: Out of 2679 primary PCI patients HDT was given upfront in 885 (33.0%) and provisionally in 812 (45.3%). Upfront as compared with provisional HDT showed higher initial patency (22.3 vs. 17.9%, p=0.006), smaller infarct size (1401 IU/l (IQR 609 to 2948) vs. 1620 (753 to 3132), p=0.03) and a lower incidence of death or recurrent MI at 30 days (3.3 vs. 5.1%, p=0.04) without an increase in TIMI bleeding (p=0.24). Upfront HDT independently predicted initial patency (odds ratio (OR) 1.47, 95% confidence interval (CI) 1.15 to 1.88, p=0.02), enzymatic infarct size (OR 0.70, 95% CI 0.56 to 0.86, p=0.001) and 30-day death or recurrent MI (OR 0.59, 95% CI 0.37 to 0.95, p=0.03).

CONCLUSION: Our findings support the use of upfront potent antiplatelet and antithrombotic therapy in STEMI patients and encourage further clinical investigations in this field. (Neth Heart J 2010;18:592-7.).

Keywords: Angioplasty; Myocardial Infarction; Timing of Drug Administration; Tirofiban

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