Journal Title
Title of Journal: Cardiovasc Drugs Ther
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Abbravation: Cardiovascular Drugs and Therapy
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Authors: Renicus S Hermanides Gert van Houwelingen Jan Paul Ottervanger MenkoJan de Boer Thorsten Dill Christian Hamm Pieter R Stella Eric Boersma Jurrien M ten Berg Arnoud W J van ’t Hof for the OnTIME 2 trial investigators
Publish Date: 2011/07/12
Volume: 25, Issue: 4, Pages: 323-
Abstract
Glycoprotein IIb/IIIa inhibitors are favourable in STelevation myocardial infarction STEMI patients and the additional value of early prehospital high bolus dose tirofiban has recently been established The aim of this study was to determine the impact of age on myocardial reperfusion and clinical outcomes of prehospital administration of high bolus dose tirofibanThis is a prespecified subanalysis of the multicentre doubleblind placebocontrolled randomised OnTIME 2 trial and it’s open label phase The primary endpoint was mean residual ST segment deviation 1 h after primary PCI and was evaluated in three age groupsOf the 466 patients in the highest tertile ≥68 years median age was 744 years IQR 713–786 years and 231 50 were randomised to tirofiban Mean residual ST segment deviation 1 h after PCI was significantly lower in elderly patients pretreated with tirofiban compared to elderly patients without tirofiban pretreatment 42 ± 52 mm vs 64 ± 75 mm p = 0001 Furthermore elderly patients pretreated with tirofiban had a nonsignificantly higher rate of 30day major or minor bleeding compared to elderly patients without tirofiban pretreatment 142 vs 90 p = 0088 30day net adverse clinical events in elderly patients with or without tirofiban was not significantly different 119 vs 152 p = 0300The effect of prehospital initiation of high bolus dose tirofiban on myocardial reperfusion as determined by STsegment resolution is highest in the elderly patients However this was associated with a trend towards more bleeding complications resulting in a balanced clinical effect after 30day followup Future studies should evaluate whether the elderly STEMI patient may benefit from highly effective and safer antiplatelet therapy
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