# GP IIb/IIIa-remmers bij acuut MI en microvasculaire obstructie: meta-analyse

*geplaatst 2024-12-16 · Algemeen · European heart journal · doi 10.1093/eurheartj/ehae587 · https://hartvaat.nl/2024/12/16/gp-iib-iiia-remmers-bij-acuut-mi-en-microvasculaire-obstructie-meta-analyse/*

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.

## English: Glycoprotein IIb/IIIa inhibitors in acute myocardial infarction and angiographic microvascular obstruction: the REVERSE-FLOW trial.

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.

## Abstract (original, from the publication)

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.

Auteurs: 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

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Bron: European heart journal, https://doi.org/10.1093/eurheartj/ehae587. Bijgewerkt 2026-07-03T13:30:24Z. 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.