ST 段抬高型心肌梗死患者的长期死亡率和院前替罗非班治疗。

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

机构信息

Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands.

Cardiovascular Department, University of Trieste, Trieste, Italy.

出版信息

Heart. 2017 Oct;103(19):1515-1520. doi: 10.1136/heartjnl-2017-311181. Epub 2017 Jul 5.

DOI:10.1136/heartjnl-2017-311181

PMID:28679686

Abstract

OBJECTIVE

We undertook a subgroup analysis of the On-TIME 2 (Ongoing Tirofiban In Myocardial infarction Evaluation 2), a placebo-controlled, double-blind, randomised trial, in order to evaluate the association between N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and long-term (5 years) mortality and to investigate the effect of prehospital tirofiban administration on mortality in relation to NT-proBNP levels.

METHODS

A total of 984 patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) were randomised to either in ambulance tirofiban or placebo. NT-proBNP levels were evaluated on admission before angiography (baseline) and 18-96 hours thereafter (post PCI).

RESULTS

There were 918 (93.3%) patients with NT-proBNP values available at baseline and 865 (87.9%) post PCI. Patients with baseline NT-proBNP values above the median (137 pg/mL) had higher 30-day (5.1% vs 0.2%, p<0.001), 1-year (7.0% vs 0.7%, p<0.001) and 5-year (20.3% vs 4.9%, p<0.001) mortality as compared with patients with values below the median. Using multivariate Cox analysis, NT-proBNP above the median was an independent predictor for 5-year mortality (HR 2.73, 95% CI 1.47 to 5.06; p=0.002). Patients with values above the median who received early tirofiban treatment had significant lower mortality compared with patients treated with placebo at 30 days (2.7% vs 7.5%, p=0.021) and 1 year (4.5% vs 9.4%, p=0.043). At 5 years, a lower but non-significant mortality rate was maintained in the treatment group (18% vs 22.4%, p=0.265).

CONCLUSIONS

In patients with STEMI, baseline NT-proBNP level independently predicts long-term mortality. In patients with baseline NT-proBNP levels above the median, early prehospital treatment with tirofiban significantly reduced 30-day and 1-year mortality, suggesting that high-risk patients may derive particular benefit. This finding should be confirmed in other studies.

TRIAL REGISTRATION NUMBER

ISRCTN06195297.

摘要

目的

我们进行了 On-TIME 2（正在进行的替罗非班在心肌梗死评估 2）的亚组分析，这是一项安慰剂对照、双盲、随机试验，以评估 N 末端 B 型利钠肽前体（NT-proBNP）水平与长期（5 年）死亡率之间的关系，并研究院前替罗非班给药与 NT-proBNP 水平相关的死亡率的影响。

方法

共有 984 例 ST 段抬高型心肌梗死（STEMI）患者接受了直接经皮冠状动脉介入治疗（PCI），随机分为救护车替罗非班组或安慰剂组。在血管造影前（基线）和此后 18-96 小时评估 NT-proBNP 水平（PCI 后）。

结果

共有 918 例（93.3%）患者在基线时具有 NT-proBNP 值，865 例（87.9%）在 PCI 后具有 NT-proBNP 值。基线 NT-proBNP 值高于中位数（137pg/mL）的患者 30 天（5.1%对 0.2%，p<0.001）、1 年（7.0%对 0.7%，p<0.001）和 5 年（20.3%对 4.9%，p<0.001）死亡率更高。使用多变量 Cox 分析，中位数以上的 NT-proBNP 是 5 年死亡率的独立预测因素（HR 2.73，95%CI 1.47 至 5.06；p=0.002）。中位数以上的患者接受早期替罗非班治疗与接受安慰剂治疗相比，30 天（2.7%对 7.5%，p=0.021）和 1 年（4.5%对 9.4%，p=0.043）的死亡率显著降低。在 5 年时，治疗组的死亡率虽然较低但无统计学意义（18%对 22.4%，p=0.265）。