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Original research article
Long-term mortality and prehospital tirofiban treatment in patients with ST elevation myocardial infarction
  1. Enrico Fabris1,2,
  2. Sinem Kilic1,
  3. Dirk A A M Schellings3,
  4. Jurrien M ten Berg4,
  5. Mark W Kennedy1,
  6. K Gerts van Houwelingen5,
  7. Evangelos Giannitsis6,
  8. Evelien Kolkman7,
  9. Jan Paul Ottervanger1,
  10. Christian Hamm8,
  11. Arnoud W J van't Hof1,9
  1. 1Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands
  2. 2Cardiovascular Department, University of Trieste, Trieste, Italy
  3. 3Slingeland Ziekenhuis, Doetinchem, The Netherlands
  4. 4Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
  5. 5Cardiology Department, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands
  6. 6Department of Cardiology, Universitats Klinik, Heidelberg, Germany
  7. 7Diagram CRO, Zwolle, The Netherlands
  8. 8Department of Cardiology, Kerckhoff Klinik, Bad Nauheim, Germany
  9. 9Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
  1. Correspondence to Professor Arnoud W J van't Hof, Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands; awjhof{at}xs4all.nl

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

  • STEMI
  • Glycoprotein IIb/IIIa inhibitors
  • tirofiban
  • NT-proBNP
  • long-term mortality.

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Footnotes

  • Contributors All authors have contributed significantly to the paper, in particular: EF, AWJVH: conception and design of the paper; EF, SK, MWK, AWJVH: drafting of the manuscript; EK: provided statistical expertise and analysis of data; DAS, JMTB, KGVH, EG, JPO, CH: revising critically the manuscript for important intellectual content.

  • Competing interests None declared.

  • Ethics approval The On-Time 2 trial was approved by the central Medical Ethics Review Committee (METC) of the Isala Ziekenhuizen of Zwolle (Netherlands) and by all local ethics committees involved.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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