| High-dose tirofiban pretreatment reduces the need for bail-out study medication in patients with ST-segment elevation myocardial infarction: results of a subgroup analysis of the On-TIME 2 trial. | |
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MedLine Citation:
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PMID: 20962338 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: This study investigated the outcome of patients who received bail-out study medication and evaluated whether high-dose tirofiban (HDT) pretreatment may reduce the need for bail-out study medication. DESIGN: A prespecified analysis of the multicentre, double-blind, placebo controlled, randomised On-TIME 2 trial. Bail-out use of study medication was predefined and part of the combined clinical end point. PATIENTS: 984 patients excluded from many coronary intervention hospitals in different countries were randomly assigned to HDT or placebo. In the subgroup who received blinded bail-out treatment, patients pretreated with placebo who received bail-out HDT were compared with those pretreated with HDT who received bail-out placebo. Interventions Routine prehospital initiation of HDT versus bail-out use of HDT. MAIN OUTCOME MEASURES: Electrocardiographic and clinical outcome. RESULTS: Blinded bail-out study medication was used in 24% (237/980) of patients, with a higher rate in patients pretreated with placebo: 29% (140/492) versus 20% (97/488), p=0.002. Bail-out versus no bail-out use of study medication was associated with more residual ST deviation (5.5±7.2 vs 3.7±4.8 mm, p=0.005), and worse clinical outcome (major adverse cardiac events (MACE) at 30 days 12.2% vs 5.6%, p<0.001), mainly due to poor outcome in patients who received HDT bail-out. In patients pretreated with HDT who received placebo bail-out study medication, residual ST deviation and clinical outcome did not differ significantly compared with patients who did not receive bail-out medication (4.0±4.6 vs 3.7± 4.8 mm, p=0.703, MACE 7.2% vs 5.6%, p=0.535). CONCLUSIONS: Routine prehospital treatment with HDT significantly reduced the use of blinded bail-out study medication. The need for bail-out therapy was associated with a less favourable outcome. This analysis suggests that routine pretreatment is superior to provisional use of HDT in patients with ST-segment elevation myocardial infarction. |
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Authors:
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R S Hermanides; A A C M Heestermans; J M Ten Berg; A T M Gosselink; J P Ottervanger; K G van Houwelingen; J J E Kolkman; P R Stella; T Dill; C Hamm; A W J van 't Hof |
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Publication Detail:
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Type: Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't Date: 2010-10-20 |
Journal Detail:
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Title: Heart (British Cardiac Society) Volume: 97 ISSN: 1468-201X ISO Abbreviation: Heart Publication Date: 2011 Jan |
Date Detail:
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Created Date: 2010-12-17 Completed Date: 2011-03-09 Revised Date: 2011-07-07 |
Medline Journal Info:
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Nlm Unique ID: 9602087 Medline TA: Heart Country: England |
Other Details:
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Languages: eng Pagination: 106-11 Citation Subset: AIM; IM |
Affiliation:
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Isala Klinieken, Zwolle, The Netherlands. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Angioplasty, Balloon, Coronary
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methods Double-Blind Method Emergency Medical Services Female Humans Male Middle Aged Myocardial Infarction / drug therapy* Platelet Aggregation Inhibitors / administration & dosage* Preoperative Care / methods Treatment Outcome Tyrosine / administration & dosage, analogs & derivatives* |
| Chemical | |
Reg. No./Substance:
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0/Platelet Aggregation Inhibitors; 144494-65-5/tirofiban; 55520-40-6/Tyrosine |
| Comments/Corrections | |
Comment In:
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Heart. 2011 Jun;97(12):1026; author reply 1026
[PMID:
21586427
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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