Premium
Effect of early tirofiban administration on N‐terminal pro‐B‐type natriuretic peptide level in patients treated with primary percutaneous coronary intervention
Author(s) -
Fabris Enrico,
Ottervanger Jan Paul,
Hermanides Renicus S.,
Berg Jurrien M.,
Sinagra Gianfranco,
Koopmans Petra C.,
Giannitsis Evangelos,
Hamm Christian,
van ‘t Hof Arnoud W. J.
Publication year - 2019
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28043
Subject(s) - medicine , tirofiban , conventional pci , percutaneous coronary intervention , cardiology , myocardial infarction , natriuretic peptide , killip class , placebo , heart failure , alternative medicine , pathology
Abstract Objectives To investigate the potential association between early tirofiban treatment and N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) level after primary percutaneous coronary intervention (PCI). Background Whether the use of adjunctive early glycoprotein IIb/IIIa inhibitors (GPIs) therapy, may affect the level of NT‐proBNP after primary PCI is poorly studied. Methods Nine hundred and eighty four ST‐elevation myocardial infarction (STEMI) patients undergoing primary PCI were randomized to either pre‐hospital tirofiban administration or placebo. NT‐proBNP levels were evaluated on admission before angiography (baseline) and 18–96 hr after PCI. Results There were 918 (93.3%) patients with NT‐proBNP values available at baseline and 865 (87.9%) post‐PCI. Post‐PCI NT‐proBNP level dichotomized with median value as cut‐off (968.8 pg/mL, IQR 430.9–1970.0) was significantly lower in patients treated with early tirofiban as compared to placebo (45.5% vs. 54.2% P = 0.011). At multivariate logistic regression analysis, independent predictors of post‐PCI NT‐proBNP level above the median were: NT‐proBNP baseline level (OR 5.19; 95% CI, 2.92–9.25, P < 0.001), Killip class>I (OR 4.07; 95% CI 1.24–13.36, P = 0.021), anterior infarct location (OR 2.61; 95% CI 1.84–3.70, P < 0.001), age (years) (OR 1.04; 95% CI 1.03–1.06, P < 0.001), male gender (OR 0.38; 95% CI 0.26–0.57, P < 0.001), prior PCI (OR 0.49; 95% CI 0.27–0.90, P = 0.021) and tirofiban administration (OR 0.71; 95% CI 0.51–0.99; P = 0.045). Conclusions In a large cohort of STEMI patients, pre‐hospital tirofiban administration was independently associate with a lower risk of high NT‐proBNP level after primary PCI, supporting the potential benefit of early antithrombotic treatment administration in STEMI patients. The trial is registered under No. ISRCTN06195297.