title: Facilitated reperfusion with prehospital glycoprotein IIb/IIIa inhibition: predictors of complete ST-segment resolution before primary percutaneous coronary intervention in the On-TIME 2 trial: correlates of reperfusion before primary PCI.
abstract: OBJECTIVE
  The objective of this study is to evaluate the incidence, predictors, and outcome of complete ST-segment resolution (STR) during transportation after pretreatment with dual or triple antiplatelet therapy in the Ongoing Tirofiban in Myocardial Infarction Evaluation (On-TIME) 2 trial.
  
  
  METHODS
  Patients with ST-segment elevation myocardial infarction were randomized in the ambulance to pretreatment with high-dose tirofiban (HDT) or to a control pretreatment (placebo or no HDT) on top of 600-mg clopidogrel, 500-mg aspirin, and 5000-IU unfractionated heparin. Complete STR was defined as ≥70% STR on the electrocardiogram obtained before percutaneous coronary intervention (PCI) as compared with the inclusion electrocardiogram.
  
  
  RESULTS
  Complete STR before PCI occurred in 16.8% (n = 188/1121) and more frequently in the HDT group (19.0% vs 14.6%, P = .05). Independent predictors for complete STR before PCI were younger age (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.70-0.96, P = .01 per 10 year increase), fast diagnosis (OR, 0.97; 95% CI, 0.97-1.0, P = .004 per 15-minute increase time from symptom onset to diagnosis), longer pretreatment time (OR, 1.09; 95% CI, 1.03-1.16, P = .003 per 15-minute increase time start study medication to angiography), and randomization to HDT (OR, 1.39; 95% CI, 1.0-1.9, P = .05). Complete STR before PCI was associated with very low 30-day (0.5% vs 2.8%, P = .07) and 1-year (1.1% vs 5.0%, P = .019) mortality.
  
  
  CONCLUSIONS
  Dual or triple antiplatelet pretreatment in the ambulance results in complete STR before PCI in 17% of patients. Fast ST-segment elevation myocardial infarction diagnosis, prehospital initiation of pretreatment early after symptom onset, and HDT independently predicted STR before PCI. Complete STR is associated with improved clinical outcome.
authors.affiliation: Department of Cardiology, Medisch Centrum Alkmaar, Alkmaar, The Netherlands.
authors.forename: Ton
authors.initials: T
authors.lastname: Heestermans
authors.forename: Harry
authors.initials: H
authors.lastname: Suryapranata
authors.forename: Jurriën M
authors.initials: JM
authors.lastname: ten Berg
authors.forename: Arend
authors.initials: A
authors.lastname: Mosterd
authors.forename: A T Marcel
authors.initials: AT
authors.lastname: Gosselink
authors.forename: Waclav
authors.initials: W
authors.lastname: Kochman
authors.forename: Thorsten
authors.initials: T
authors.lastname: Dill
authors.forename: Gert
authors.initials: G
authors.lastname: van Houwelingen
authors.forename: Evelien
authors.initials: E
authors.lastname: Kolkman
authors.forename: Jochem W
authors.initials: JW
authors.lastname: van Werkum
authors.forename: Felix
authors.initials: F
authors.lastname: Zijlstra
authors.forename: Christian
authors.initials: C
authors.lastname: Hamm
authors.forename: Arnoud W J
authors.initials: AW
authors.lastname: van 't Hof
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003131:Combined Modality Therapy; D004562:Electrocardiography / Q000379:methods*; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000627:therapeutic use; D011292:Premedication / Q000379:methods*; D011379:Prognosis; D000077466:Tirofiban; D016896:Treatment Outcome; D014443:Tyrosine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D014443:Tyrosine; D000077466:Tirofiban