{"id":"6a2d0592d814","type":"article","url":"https://hartvaat.nl/2017/10/01/langetermijnmortaliteit-en-prehospitale-tirofibanbehandeling-bij-stemi/","title":"Langetermijnmortaliteit en prehospitale tirofibanbehandeling bij STEMI","title_en":"Long-term mortality and prehospital tirofiban treatment in patients with ST elevation myocardial infarction.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2017-311181","source_url":"https://doi.org/10.1136/heartjnl-2017-311181","authors":["Enrico Fabris","Sinem Kilic","Dirk A A M Schellings","Jurrien M Ten Berg","Mark W Kennedy","K Gerts van Houwelingen","Evangelos Giannitsis","Evelien Kolkman","Jan Paul Ottervanger","Christian Hamm","Arnoud W J Van't Hof"],"significance":5,"published":"2017-10-01","source_date":"2017-10-01","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/peripartum-cardiomyopathie/"],"congress":"","summary_en":"This On-TIME 2 subgroup analysis evaluated long-term mortality outcomes in STEMI patients who received prehospital tirofiban, assessing the durability of early glycoprotein IIb/IIIa inhibitor treatment benefit.","created":"2026-07-03T10:26:55Z","updated":"2026-07-03T13:26:12Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar langetermijnmortaliteit bij STEMI-patiënten die prehospitaal tirofiban ontvingen. Onderzoekt de waarde van vroege GPIIb/IIIa-remming vóór het cathlab.","abstract_original":"OBJECTIVE: We undertook a subgroup analysis of the On-TIME 2 (Ongoing Tirofiban In Myocardial infarction Evaluation 2), a placebo-controlled, double-blind, randomised trial, in order to evaluate the association between N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and long-term (5 years) mortality and to investigate the effect of prehospital tirofiban administration on mortality in relation to NT-proBNP levels. METHODS: A total of 984 patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) were randomised to either in ambulance tirofiban or placebo. NT-proBNP levels were evaluated on admission before angiography (baseline) and 18-96 hours thereafter (post PCI). RESULTS: There were 918 (93.3%) patients with NT-proBNP values available at baseline and 865 (87.9%) post PCI. Patients with baseline NT-proBNP values above the median (137 pg/mL) had higher 30-day (5.1% vs 0.2%, p<0.001), 1-year (7.0% vs 0.7%, p<0.001) and 5-year (20.3% vs 4.9%, p<0.001) mortality as compared with patients with values below the median. Using multivariate Cox analysis, NT-proBNP above the median was an independent predictor for 5-year mortality (HR 2.73, 95% CI 1.47 to 5.06; p=0.002). Patients with values above the median who received early tirofiban treatment had significant lower mortality compared with patients treated with placebo at 30 days (2.7% vs 7.5%, p=0.021) and 1 year (4.5% vs 9.4%, p=0.043). At 5 years, a lower but non-significant mortality rate was maintained in the treatment group (18% vs 22.4%, p=0.265). CONCLUSIONS: In patients with STEMI, baseline NT-proBNP level independently predicts long-term mortality. In patients with baseline NT-proBNP levels above the median, early prehospital treatment with tirofiban significantly reduced 30-day and 1-year mortality, suggesting that high-risk patients may derive particular benefit. This finding should be confirmed in other studies. TRIAL REGISTRATION NUMBER: ISRCTN06195297."}