Key result
Pre-hospital administration of tirofiban in diabetic STEMI patients undergoing primary PCI reduced residual ST deviation (5.1 vs 6.2 mm, p=0.003) and infarct size.
Why the study?
Does pre-hospital administration of high dose tirofiban improve ST resolution and reduce infarct size in diabetic patients with STEMI undergoing primary PCI?
RCT (n=220)
Randomized
Does pre-hospital administration of high dose tirofiban improve ST resolution and reduce infarct size in diabetic patients with STEMI undergoing primary PCI?
Absolute Event Rate: 5.1% vs 6.2%
p-value: p=0.003
Pre-hospital administration of high-dose tirofiban improves ST-segment resolution and reduces infarct size specifically in diabetic patients with STEMI undergoing primary PCI.
Supports pre-hospital tirofiban in diabetic STEMI undergoing primary PCI; extends RCT evidence to this high-risk subgroup.
AIMS: Glycoprotein IIb/IIIa blocking agents seem to improve percutaneous coronary intervention (PCI) results in patients with ST-elevation myocardial infarction (STEMI). We aimed to compare the effect of pre-hospital administration of tirofiban in STEMI patients with and without diabetes mellitus (DM) treated with primary PCI. METHODS AND RESULTS: We performed a pre-specified sub-analysis of the randomised On-Time II trial (n=984) and it's open label run-in phase (n=414), which investigated pre-hospital administration of high dose tirofiban in STEMI patients treated with primary PCI. Two-hundred and twenty (16%) diabetic patients (known DM or Hba1C ≥6.2%) were included, 101 in the placebo group and 119 in the tirofiban group. In patients with DM, randomisation to tirofiban resulted in a lower residual ST deviation (5.1±8.5 mm vs. 6.2±5.6 mm, p=0.003), a reduced infarct size (CK 1694±1925 U/L vs. CK 2040±1829 U/L, p=0.02) and a trend towards lower one-year mortality (4.6% vs. 11.6%, p=0.07). The beneficial effects of tirofiban were more pronounced in diabetic patients compared to patients without diabetes. CONCLUSIONS: Pre-hospital administration of tirofiban in diabetic STEMI patients treated with primary PCI improves ST resolution and reduces myocardial infarct size. Tirofiban seems particularly beneficial in patients with diabetes.
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Timmer et al. (2010) conducted an RCT in ST-elevation myocardial infarction (STEMI) with diabetes mellitus (n=220). Tirofiban vs. Placebo was evaluated on Residual ST deviation (p=0.003). Pre-hospital administration of tirofiban in diabetic STEMI patients undergoing primary PCI reduced residual ST deviation (5.1 vs 6.2 mm, p=0.003) and infarct size.
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