PMID- 28679686
OWN - NLM
STAT- MEDLINE
DCOM- 20170919
LR  - 20181202
IS  - 1468-201X (Electronic)
IS  - 1355-6037 (Linking)
VI  - 103
IP  - 19
DP  - 2017 Oct
TI  - Long-term mortality and prehospital tirofiban treatment in patients with ST 
      elevation myocardial infarction.
PG  - 1515-1520
LID - 10.1136/heartjnl-2017-311181 [doi]
AB  - 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.
CI  - (c) Article author(s) (or their employer(s) unless otherwise stated in the text of 
      the article) 2017. All rights reserved. No commercial use is permitted unless 
      otherwise expressly granted.
FAU - Fabris, Enrico
AU  - Fabris E
AD  - Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands.
AD  - Cardiovascular Department, University of Trieste, Trieste, Italy.
FAU - Kilic, Sinem
AU  - Kilic S
AD  - Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands.
FAU - Schellings, Dirk A A M
AU  - Schellings DAAM
AD  - Slingeland Ziekenhuis, Doetinchem, The Netherlands.
FAU - Ten Berg, Jurrien M
AU  - Ten Berg JM
AD  - Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands.
FAU - Kennedy, Mark W
AU  - Kennedy MW
AD  - Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands.
FAU - van Houwelingen, K Gerts
AU  - van Houwelingen KG
AD  - Cardiology Department, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, 
      The Netherlands.
FAU - Giannitsis, Evangelos
AU  - Giannitsis E
AD  - Department of Cardiology, Universitats Klinik, Heidelberg, Germany.
FAU - Kolkman, Evelien
AU  - Kolkman E
AD  - Diagram CRO, Zwolle, The Netherlands.
FAU - Ottervanger, Jan Paul
AU  - Ottervanger JP
AD  - Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands.
FAU - Hamm, Christian
AU  - Hamm C
AD  - Department of Cardiology, Kerckhoff Klinik, Bad Nauheim, Germany.
FAU - Van't Hof, Arnoud W J
AU  - Van't Hof AWJ
AD  - Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands.
AD  - Department of Cardiology, Maastricht University Medical Center, Maastricht, The 
      Netherlands.
LA  - eng
SI  - ISRCTN/ISRCTN06195297
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
DEP - 20170705
PL  - England
TA  - Heart
JT  - Heart (British Cardiac Society)
JID - 9602087
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 42HK56048U (Tyrosine)
RN  - GGX234SI5H (Tirofiban)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Dose-Response Relationship, Drug
MH  - Double-Blind Method
MH  - *Electrocardiography
MH  - Emergency Medical Services/*methods
MH  - Europe/epidemiology
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Infusions, Intravenous
MH  - Male
MH  - Middle Aged
MH  - Platelet Aggregation Inhibitors/administration & dosage
MH  - ST Elevation Myocardial Infarction/diagnosis/drug therapy/*mortality
MH  - Survival Rate/trends
MH  - Time Factors
MH  - Tirofiban
MH  - Treatment Outcome
MH  - Tyrosine/administration & dosage/*analogs & derivatives
MH  - Young Adult
OTO - NOTNLM
OT  - Glycoprotein IIb/IIIa inhibitors
OT  - NT-proBNP
OT  - STEMI
OT  - long-term mortality.
OT  - tirofiban
COIS- Competing interests: None declared.
EDAT- 2017/07/07 06:00
MHDA- 2017/09/20 06:00
CRDT- 2017/07/07 06:00
PHST- 2017/01/10 00:00 [received]
PHST- 2017/05/09 00:00 [revised]
PHST- 2017/05/10 00:00 [accepted]
PHST- 2017/07/07 06:00 [pubmed]
PHST- 2017/09/20 06:00 [medline]
PHST- 2017/07/07 06:00 [entrez]
AID - heartjnl-2017-311181 [pii]
AID - 10.1136/heartjnl-2017-311181 [doi]
PST - ppublish
SO  - Heart. 2017 Oct;103(19):1515-1520. doi: 10.1136/heartjnl-2017-311181. Epub 2017 
      Jul 5.