Netherlands Heart Journal

, Volume 18, Issue 12, pp 592–597

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
  • 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
Original Article

DOI: 10.1007/s12471-010-0840-z

Cite this article as:
Heestermans, A., Hermanides, R., Gosselink, A. et al. Neth Heart J (2010) 18: 592. doi:10.1007/s12471-010-0840-z

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

TirofibanMyocardial InfarctionAngioplastyTiming of Drug Administration

Copyright information

© Springer Media / Bohn Stafleu van Loghum 2010

Authors and Affiliations

  • A.A.C.M. Heestermans
    • 1
  • R.S. Hermanides
    • 2
  • A.T.M. Gosselink
    • 2
  • M.J. de Boer
    • 2
  • J.C.A. Hoorntje
    • 2
  • H. Suryapranata
    • 2
  • J.P. Ottervanger
    • 2
  • J-H.E. Dambrink
    • 2
  • E. Kolkman
    • 3
  • J.M. ten Berg
    • 4
  • F. Zijlstra
    • 5
  • A.W.J. van ’t Hof
    • 6
  1. 1.Department of CardiologyMedical Centre AlkmaarAlkmaarthe Netherlands
  2. 2.Department of CardiologyIsala KliniekenZwollethe Netherlands
  3. 3.Department of Medical StatisticsDiagram BVZwollethe Netherlands
  4. 4.Department of CardiologySt. Antonius HospitalNieuwegeinthe Netherlands
  5. 5.Department of CardiologyUniversity Medical Center GroningenGroningenthe Netherlands
  6. 6.Department of CardiologyIsala Klinieken, location WeezenlandenZwollethe Netherlands