{"id":"9e243aaa06b3","type":"article","url":"https://hartvaat.nl/2024/12/16/gp-iib-iiia-remmers-bij-acuut-mi-en-microvasculaire-obstructie-meta-analyse/","title":"GP IIb/IIIa-remmers bij acuut MI en microvasculaire obstructie: meta-analyse","title_en":"Glycoprotein IIb/IIIa inhibitors in acute myocardial infarction and angiographic microvascular obstruction: the REVERSE-FLOW trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["abelacimab","acuut-hartfalen","biomarkers-cardiovasculair","bloeddrukbehandeling","ezetimibe","farmaco-economie","microcirculatie","microvasculaire-angina","myocardinfarct","obesitas","ouderen","ras-remmers"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehae587","source_url":"https://doi.org/10.1093/eurheartj/ehae587","authors":["Ingo Eitel","Roza Saraei","Dominik Jurczyk","Andreas Fach","Rainer Hambrecht","Harm Wienbergen","Christian Frerker","Tobias Schmidt","Abdelhakim Allali","Alexander Joost","Christoph Marquetand","Thomas Kurz","Philip Haaf","Gregor Fahrni","Christian Mueller","Steffen Desch","Holger Thiele","Thomas Stiermaier"],"significance":5,"published":"2024-12-16","source_date":"2024-12-16","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/antiaritmica-farmacologie/"],"congress":"","summary_en":"The REVERSE-FLOW trial randomised patients with acute myocardial infarction and angiographic microvascular obstruction to GP IIb/IIIa inhibitors versus standard care. The antiplatelet agents modestly reduced microvascular obstruction but did not significantly improve hard clinical endpoints.","created":"2026-07-03T10:31:23Z","updated":"2026-07-03T13:30:24Z","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":"Meta-analyse onderzocht het effect van GP IIb/IIIa-remmers op angiografische microvasculaire obstructie bij acuut MI. De middelen verminderden MVO bescheiden maar het effect op harde klinische eindpunten was beperkt.","abstract_original":"BACKGROUND AND AIMS: Glycoprotein (GP) IIb/IIIa inhibitors are recommended in acute myocardial infarction (AMI) for bailout treatment in case of angiographic microvascular obstruction (MVO), also termed no-reflow phenomenon, after percutaneous coronary intervention (PCI) with, however, lacking evidence (class IIa, level C). METHODS: The investigator-initiated, international, multicentre REVERSE-FLOW trial randomized 120 patients with AMI and thrombolysis in myocardial infarction flow grade ≤ 2 after primary PCI to optimal medical therapy with or without GP IIb/IIIa inhibitor. The primary endpoint was infarct size [percentage of left ventricular (LV) mass assessed by cardiac magnetic resonance (CMR). Secondary endpoints included CMR-derived MVO and 30-day adverse clinical events. The trial is registered with ClinicalTrials.gov: NCT02739711. RESULTS: The population was predominantly male (76.7%) with a median age of 66 years and ST-elevation myocardial infarction in 73.3% of patients. Clinical and angiographic characteristics were well balanced between the cohorts. Patients in the treatment group (n = 62) received eptifibatide (n = 41) or tirofiban (n = 21). Infarct size assessed by CMR imaging was similar in both study groups [25.4% of LV mass (%LV) vs. 25.2%LV; P = .386]. However, the number of patients with evidence of CMR-derived MVO (74.5% vs. 92.2%; P = .017) and the extent of MVO (2.1%LV vs. 3.4%LV; P = .025) were significantly reduced in the GP IIb/IIIa inhibitor group compared with controls. Thirty-day outcome showed an increased bleeding risk after GP IIb/IIIa inhibitor administration restricted to non-life-threatening bleedings (22.6% vs. 6.9%; P = .016) without differences in all-cause mortality (4.8% vs. 3.4%; P = .703). CONCLUSIONS: Bailout GP IIb/IIIa inhibition in AMI patients with angiographic MVO failed to reduce the primary endpoint infarct size but decreased CMR-derived MVO and led to an increase in non-fatal bleeding events."}