Prehospital high-dose tirofiban in patients undergoing primary percutaneous intervention. The AGIR-2 study.
BACKGROUND
Compared with administration in the catheterization laboratory, early treatment with glycoprotein IIb/IIIa inhibitors provides benefits to patients with ST-segment elevation myocardial infarction who undergo primary percutaneous intervention. Whether this benefit is maintained on top of a 600 mg loading dose of clopidogrel is unknown.


METHODS
In a multicentre, controlled, randomized study, 320 patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention received a high-dose bolus of tirofiban given either in the ambulance (prehospital group) or in the catheterization laboratory. The primary endpoint was a TIMI flow grade 2-3 of the infarct-related vessel at initial angiography. Secondary endpoints included ST-segment resolution 1h after percutaneous coronary intervention and peak serum troponin I concentration.


RESULTS
Tirofiban was administered 48 (95% confidence interval 21.4-75.0) min earlier in the prehospital group. At initial angiography, the combined incidence of TIMI 2-3 flow was 39.7% in the catheterization-laboratory group and 44.2% in the prehospital group (p=0.45). No difference was found on postpercutaneous intervention angiography or peak troponin concentration. Complete ST-segment resolution 60 min after the start of intervention was 55.4% in the catheterization-laboratory group and 52.6% in the prehospital group (p=0.32).


CONCLUSIONS
Prehospital initiation of high-dose bolus tirofiban did not improve significantly initial TIMI 2 or 3 flow of the infarct-related artery or complete ST-segment resolution after coronary intervention compared with initiation of tirofiban in the catheterization laboratory (NCT00538317).
El Khoury
Carlos
C
RESCUE Network, Hussel Hospital, Vienne, France.
Dubien
Pierre-Yves
PY
Mercier
Catherine
C
Belle
Loic
L
Debaty
Guilaume
G
Capel
Olivier
O
Perret
Thibault
T
Savary
Dominique
D
Serre
Patrice
P
Bonnefoy
Eric
E
D000552:Ambulances; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers / Q000097:blood; D000077144:Clopidogrel; D017023:Coronary Angiography; D003326:Coronary Circulation; D003402:Creatine Kinase / Q000097:blood; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004632:Emergency Medical Services; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D013997:Time Factors; D000077466:Tirofiban; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood; D014443:Tyrosine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
D015415:Biomarkers; D010975:Platelet Aggregation Inhibitors; D019210:Troponin I; D014443:Tyrosine; D000077144:Clopidogrel; D003402:Creatine Kinase; D000077466:Tirofiban; D013988:Ticlopidine