Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.
Eur Heart J Acute Cardiovasc Care. 2024 Aug 28;13(8):595-601. doi: 10.1093/ehjacc/zuae074.
In patients with ST-segment elevation myocardial infarction (STEMI), prehospital tirofiban significantly improved myocardial reperfusion. However, its impact on the rate of disrupted myocardial infarction (MI), particularly in the context of high-sensitivity cardiac troponin (hs-cTn) assays, is still unclear.
The On-TIME 2 (Ongoing Tirofiban In Myocardial infarction Evaluation 2) trial randomly assigned STEMI patients to prehospital tirofiban or placebo before transportation to a percutaneous coronary intervention (PCI) centre. In this post hoc analysis, we evaluated STEMI patients that underwent primary PCI and had measured hs-cTn levels. Troponin T levels were collected at 18-24 and 72-96 h after PCI. Disrupted MI was defined as peak hs-cTn T levels ≤ 10 times the upper limit of normal (≤140 ng/L). Out of 786 STEMI patients, 47 (6%) had a disrupted MI. Disrupted MI occurred in 31 of 386 patients (8.0%) in the tirofiban arm and in 16 of 400 patients (4.0%) in the placebo arm (P = 0.026). After multivariate adjustment, prehospital tirofiban remained independently associated with disrupted MI (odds ratio 2.03; 95% confidence interval 1.10-3.87; P = 0.027). None of the patients with disrupted MI died during the 1-year follow-up, compared with a mortality rate of 2.6% among those without disrupted MI.
Among STEMI patients undergoing primary PCI, the use of prehospital tirofiban was independently associated with a higher rate of disrupted MI. These results, highlighting a potential benefit, underscore the need for future research focusing on innovative pre-treatment approaches that may increase the rate of disrupted MI.
在 ST 段抬高型心肌梗死（STEMI）患者中，院前替罗非班显著改善了心肌再灌注。然而，其对心肌梗死破裂（MI）发生率的影响，特别是在高敏心肌肌钙蛋白（hs-cTn）检测的背景下，仍不清楚。
On-TIME 2（持续替罗非班在心肌梗死评估 2）试验将 STEMI 患者随机分配至院前替罗非班组或安慰剂组，然后转运至经皮冠状动脉介入（PCI）中心。在这项事后分析中，我们评估了接受直接 PCI 且 hs-cTn 水平可测量的 STEMI 患者。于 PCI 后 18-24 小时和 72-96 小时采集肌钙蛋白 T 水平。破裂性 MI 的定义为 hs-cTn T 峰值水平≤正常上限的 10 倍（≤140ng/L）。在 786 例 STEMI 患者中，有 47 例（6%）发生破裂性 MI。替罗非班组中，386 例患者中有 31 例（8.0%）发生破裂性 MI，安慰剂组中有 400 例患者中有 16 例（4.0%）发生破裂性 MI（P=0.026）。多变量调整后，院前替罗非班与破裂性 MI 仍独立相关（优势比 2.03；95%置信区间 1.10-3.87；P=0.027）。在 1 年随访期间，破裂性 MI 患者无一例死亡，而无破裂性 MI 患者的死亡率为 2.6%。
在接受直接 PCI 的 STEMI 患者中，院前替罗非班的使用与破裂性 MI 发生率升高独立相关。这些结果强调了创新治疗前方法的潜在益处，需要进一步研究，以提高破裂性 MI 的发生率。
