Advertisement

Impact of Time from Symptom Onset to Drug Administration on Outcome in Patients Undergoing Glycoprotein IIb-IIIa Facilitated Primary Angioplasty (from the EGYPT Cooperation)

Published:January 05, 2015DOI:https://doi.org/10.1016/j.amjcard.2014.12.030
      Contrasting data have been so far reported on facilitation with glycoprotein IIb-IIIa inhibitors (GpIIbIIIa) in patients who underwent primary percutaneous coronary intervention. However, it has been demonstrated a time-dependent composition of coronary thrombus in ST-segment elevation myocardial infarction, with more platelets in the first hours. Subsequently, the benefits of early administration of GpIIbIIIa may be affected by the time from symptoms onset to GpIIbIIIa, that therefore is the aim of this study. Our population is represented by 814 patients who underwent GpIIbIIIa facilitated primary angioplasty included in the Early glycoprotein IIb-IIIa inhibitors in primary angioplasty database. Patients were divided according to quartiles of time from symptom onset to GpIIbIIIa administration (≤65 minutes; 65 to 100 minutes; 101 to 178 minutes; and >178 minutes). Myocardial perfusion was evaluated by myocardial blush grade and ST-segment resolution. Time from symptoms onset to GpIIbIIIa was linearly associated with hypertension, diabetes, hypercholesterolemia, and previous myocardial infarction but inversely associated with smoking. Abciximab was more often administrated later from symptoms onset. Time from symptoms onset to GpIIbIIIa was significantly associated with the rate of preprocedural recanalization (thrombolysis in myocardial infarction [TIMI] 2 to 3; p <0.001), postprocedural TIMI 3 flow (p <0.001), the rate of complete ST-segment resolution (p <0.001), and the rate of myocardial blush grade 2 to 3 (p <0.001) and inversely associated with the occurrence of distal embolization (p <0.001). Follow-up data were collected at a median (twenty-fifth to seventy-fifth) of 360 (30 to 1,095) days. A total of 52 patients had died. Time to GpIIbIIIa had a significant impact on mortality (hazard ratio [95% confidence interval] 1.46 [1.11 to 1.92], p = 0.007) that was confirmed after correction for baseline confounding factors (adjusted hazard ratio [95% confidence interval] 1.41 [1.02 to 2.21], p = 0.042). In conclusion, this study showed that in patients who underwent primary angioplasty with upstream GpIIbIIIa, time from symptoms onset to GpIIbIIIa strongly impacts on preprocedural recanalization, distal embolization, myocardial perfusion, and long-term survival.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • De Luca G.
        • Cassetti E.
        • Marino P.
        Percutaneous coronary intervention-related time delay, patient's risk profile, and survival benefits of primary angioplasty vs lytic therapy in ST-segment elevation myocardial infarction.
        Am J Emerg Med. 2009; 27: 712-719
        • De Luca G.
        • Suryapranata H.
        • Marino P.
        Reperfusion strategies in acute ST-elevation myocardial infarction: an overview of current status.
        Prog Cardiovasc Dis. 2008; 50: 352-382
        • De Luca G.
        • Smit J.J.
        • Ernst N.
        • Suryapranata H.
        • Ottervanger J.P.
        • Hoorntje J.C.
        • Dambrink J.H.
        • Gosslink A.T.
        • de Boer M.J.
        • van 't Hof A.W.
        Impact of adjunctive tirofiban administration on myocardial perfusion and mortality in patients undergoing primary angioplasty for ST-segment elevation myocardial infarction.
        Thromb Haemost. 2005; 93: 820-823
        • De Luca G.
        • Marino P.
        Adjunctive benefits from low-molecular-weight heparins as compared to unfractionated heparin among patients with ST-segment elevation myocardial infarction treated with thrombolysis. A meta-analysis of the randomized trials.
        Am Heart J. 2007; 154: 1-1085.e6
        • De Luca G.
        • Cassetti E.
        • Verdoia M.
        • Marino P.
        Bivalirudin as compared to unfractionated heparin among patients undergoing coronary angioplasty: a meta-analyis of randomised trials.
        Thromb Haemost. 2009; 102: 428-436
        • Newby L.K.
        • Rutsch W.R.
        • Califf R.M.
        • Simoons M.L.
        • Aylward P.E.
        • Armstrong P.W.
        • Woodlief L.H.
        • Lee K.L.
        • Topol E.J.
        • Van de Werf F.
        Time from symptom onset to treatment and outcomes after thrombolyitc therapy.
        J Am Coll Cardiol. 1996; 27: 1646-1655
        • Brodie B.R.
        • Stuckey T.D.
        • Wall T.C.
        • Kissling G.
        • Hansen C.J.
        • Muncy D.B.
        • Weintraub R.A.
        • Kelly T.A.
        Importance of time to reperfusion for 30-day and late survival and recovery of left ventricular function after primary angioplasty for acute myocardial infarction.
        J Am Coll Cardiol. 1998; 32: 1312-1319
        • De Luca G.
        • Suryapranata H.
        • Ottervanger J.P.
        • Antman E.M.
        Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction: every minute of delay counts.
        Circulation. 2004; 109: 1223-1225
        • De Luca G.
        • Ernst N.
        • Suryapranata H.
        • Ottervanger J.P.
        • Hoorntje J.C.
        • Gosselink A.T.
        • Dambrink J.H.
        • de Boer M.J.
        • van 't Hof A.W.
        Relation of interhospital delay and mortality in patients with ST-segment elevation myocardial infarction transferred for primary coronary angioplasty.
        Am J Cardiol. 2005; 95: 1361-1363
        • Maeng M.
        • Nielsen P.H.
        • Busk M.
        • Mortensen L.S.
        • Kristensen S.D.
        • Nielsen T.T.
        • Andersen H.R.
        • DANAMI-2 Investigators
        Time to treatment and three-year mortality after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction-a DANish Trial in Acute Myocardial Infarction-2 (DANAMI-2) substudy.
        Am J Cardiol. 2010; 105: 1528-1534
        • De Luca G.
        • Marino P.
        Facilitated angioplasty with combo therapy among patients with ST-segment elevation myocardial infarction: a meta-analysis of randomized trials.
        Am J Emerg Med. 2009 Jul; 27: 683-690
        • De Luca G.
        • Gibson C.M.
        • Bellandi F.
        • Murphy S.
        • Maioli M.
        • Noc M.
        • Zeymer U.
        • Dudek D.
        • Arntz H.R.
        • Zorman S.
        • Gabriel H.M.
        • Emre A.
        • Cutlip D.
        • Biondi-Zoccai G.
        • Rakowski T.
        • Gyongyosi M.
        • Marino P.
        • Huber K.
        • van't Hof A.W.
        Early glycoprotein IIb-IIIa inhibitors in primary angioplasty (EGYPT) cooperation: an individual patient data meta-analysis.
        Heart. 2008; 94: 1548-1558
        • De Luca G.
        • Bellandi F.
        • Huber K.
        • Noc M.
        • Petronio A.S.
        • Arntz H.R.
        • Maioli M.
        • Gabriel H.M.
        • Zorman S.
        • DE Carlo M.
        • Rakowski T.
        • Gyongyosi M.
        • Dudek D.
        Early glycoprotein IIb-IIIa inhibitors in primary angioplasty-abciximab long-term results (EGYPT-ALT) cooperation: individual patient's data meta-analysis.
        J Thromb Haemost. 2011; 9: 2361-2370
        • Van't Hof A.W.
        • Ten Berg J.
        • Heestermans T.
        • Dill T.
        • Funck R.C.
        • van Werkum W.
        • Dambrink J.H.
        • Suryapranata H.
        • van Houwelingen G.
        • Ottervanger J.P.
        • Stella P.
        • Giannitsis E.
        • Hamm C.
        • Ongoing Tirofiban In Myocardial infarction Evaluation (On-TIME) 2 study group
        Prehospital initiation of tirofiban in patients with ST-elevation myocardial infarction undergoing primary angioplasty (On-TIME 2): a multicentre, double-blind, randomised controlled trial.
        Lancet. 2008; 372: 537-546
        • Dudek D.
        • Siudak Z.
        • Janzon M.
        • Birkemeyer R.
        • Aldama-Lopez G.
        • Lettieri C.
        • Janus B.
        • Wisniewski A.
        • Berti S.
        • Olivari Z.
        • Rakowski T.
        • Partyka L.
        • Goedicke J.
        • Zmudka K.
        • EUROTRANSFER Registry Investigators
        European registry on patients with ST-elevation myocardial infarction transferred for mechanical reperfusion with a special focus on early administration of abciximab—EUROTRANSFER Registry.
        Am Heart J. 2008; 156: 1147-1154
        • Ortolani P.
        • Marzocchi A.
        • Marrozzini C.
        • Palmerini T.
        • Saia F.
        • Taglieri N.
        • Baldazzi F.
        • Dall'Ara G.
        • Nardini P.
        • Gianstefani S.
        • Guastaroba P.
        • Grilli R.
        • Branzi A.
        Long-term effectiveness of early administration of glycoprotein IIb/IIIa agents to real-world patients undergoing primary percutaneous interventions: results of a registry study in an ST-elevation myocardial infarction network.
        Eur Heart J. 2009; 30: 33-43
        • Hassan A.K.
        • Liem S.S.
        • van der Kley F.
        • Bergheanu S.C.
        • Wolterbeek R.
        • Bosch J.
        • Bootsma M.
        • Zeppenfeld K.
        • van der Laarse A.
        • Atsma D.E.
        • Jukema J.W.
        • Schalij M.J.
        In-ambulance abciximab administration in STEMI patients prior to primary PCI is associated with smaller infarct size, improved LV function and lower incidence of heart failure: results from the Leiden MISSION! acute myocardial infarction treatment optimization program.
        Catheter Cardiovasc Interv. 2009; 74: 335-343
        • Huber K.
        • Holmes Jr., D.R.
        • van 't Hof A.W.
        • Montalescot G.
        • Aylward P.E.
        • Betriu G.A.
        • Widimsky P.
        • Westerhout C.M.
        • Granger C.B.
        • Armstrong P.W.
        Use of glycoprotein IIb/IIIa inhibitors in primary percutaneous coronary intervention: insights from the APEX-AMI trial.
        Eur Heart J. 2010; 31: 1708-1716
        • Ellis S.G.
        • Tendera M.
        • de Belder M.A.
        • van Boven A.J.
        • Widimsky P.
        • Janssens L.
        • Andersen H.R.
        • Betriu A.
        • Savonitto S.
        • Adamus J.
        • Peruga J.Z.
        • Kosmider M.
        • Katz O.
        • Neunteufl T.
        • Jorgova J.
        • Dorobantu M.
        • Grinfeld L.
        • Armstrong P.
        • Brodie B.R.
        • Herrmann H.C.
        • Montalescot G.
        • Neumann F.J.
        • Effron M.B.
        • Barnathan E.S.
        • Topol E.J.
        • FINESSE Investigators
        Facilitated PCI in patients with ST-elevation myocardial infarction.
        N Engl J Med. 2008; 358: 2205-2217
        • Silvain J.
        • Collet J.P.
        • Nagaswami C.
        • Beygui F.
        • Edmondson K.E.
        • Bellemain-Appaix A.
        • Cayla G.
        • Pena A.
        • Brugier D.
        • Barthelemy O.
        • Montalescot G.
        • Weisel J.W.
        Composition of coronary thrombus in acute myocardial infarction.
        J Am Coll Cardiol. 2011; 57: 1359-1367
        • De Luca G.
        • van 't Hof A.W.
        • Ottervanger J.P.
        • Hoorntje J.C.
        • Gosselink A.T.
        • Dambrink J.H.
        • Zijlstra F.
        • de Boer M.J.
        • Suryapranata H.
        Unsuccessful reperfusion in patients with ST-segment elevation myocardial infarction treated by primary angioplasty.
        Am Heart J. 2005; 150: 557-562
        • De Luca G.
        • Suryapranata H.
        • de Boer M.J.
        • Ottervanger J.P.
        • Hoorntje J.C.
        • Gosselink A.T.
        • Dambrink J.H.
        • van't Hof A.W.
        Impact of vessel size on distal embolization, myocardial perfusion and clinical outcome in patients undergoing primary angioplasty for ST-segment elevation myocardial infarction.
        J Thromb Thrombolysis. 2009; 27: 198-203
        • Assessment of the Safety and Efficacy of a New Treatment Strategy with Percutaneous Coronary Intervention (ASSENT-4 PCI) investigators
        Primary versus tenecteplase-facilitated percutaneous coronary intervention in patients with ST-segment elevation acute myocardial infarction (ASSENT-4 PCI): randomised trial.
        Lancet. 2006; 367: 569-578
        • Herrmann H.C.
        • Lu J.
        • Brodie B.R.
        • Armstrong P.W.
        • Montalescot G.
        • Betriu A.
        • Neuman F.J.
        • Effron M.B.
        • Barnathan E.S.
        • Topol E.J.
        • Ellis S.G.
        • FINESSE Investigators
        Benefit of facilitated percutaneous coronary intervention in high-risk ST-segment elevation myocardial infarction patients presenting to nonpercutaneous coronary intervention hospitals.
        JACC Cardiovasc Interv. 2009; 2: 917-924
        • Ellis S.G.
        • Tendera M.
        • de Belder M.A.
        • van Boven A.J.
        • Widimsky P.
        • Andersen H.R.
        • Betriu A.
        • Savonitto S.
        • Adamus J.
        • Peruga J.Z.
        • Hamankiewicz M.
        • Pluta W.
        • Oldroyd K.
        • Ecollan P.
        • Janssens L.
        • Armstrong P.
        • Brodie B.R.
        • Herrmann H.C.
        • Montalescot G.
        • Neumann F.J.
        • Effron M.B.
        • Barnathan E.S.
        • Topol E.J.
        • FINESSE Investigators
        1-year survival in a randomized trial of facilitated reperfusion: results from the FINESSE (Facilitated Intervention with Enhanced Reperfusion Speed to Stop Events) trial.
        JACC Cardiovasc Interv. 2009; 2: 909-916
        • Windecker S.
        • Kolh P.
        • Alfonso F.
        • Collet J.P.
        • Cremer J.
        • Falk V.
        • Filippatos G.
        • Hamm C.
        • Head S.J.
        • Jüni P.
        • Kappetein A.P.
        • Kastrati A.
        • Knuuti J.
        • Landmesser U.
        • Laufer G.
        • Neumann F.J.
        • Richter D.J.
        • Schauerte P.
        • Sousa Uva M.
        • Stefanini G.G.
        • Taggart D.P.
        • Torracca L.
        • Valgimigli M.
        • Wijns W.
        • Witkowski A.
        • Authors/Task Force members
        • Authors/Task Force members
        2014 ESC/EACTS guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of cardiology (ESC) and the European Association for Cardio-Thoracic surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI).
        Eur Heart J. 2014; 35: 2541-2619
        • De Luca G.
        • van't Hof A.W.
        • de Boer M.J.
        • Ottervanger J.P.
        • Hoorntje J.C.
        • Gosselink A.T.
        • Dambrink J.H.
        • Zijlstra F.
        • Suryapranata H.
        Time-to-treatment significantly affects the extent of ST-segment resolution and myocardial blush in patients with acute myocardial infarction treated by primary angioplasty.
        Eur Heart J. 2004; 25: 1009-1013
        • Stone G.W.
        • Dixon S.R.
        • Grines C.L.
        • Cox D.A.
        • Webb J.G.
        • Brodie B.R.
        • Griffin J.J.
        • Martin J.L.
        • Fahy M.
        • Mehran R.
        • Miller T.D.
        • Gibbons R.J.
        • O'Neill W.W.
        Predictors of infarct size after primary coronary angioplasty in acute myocardial infarction from pooled analysis from four contemporary trials.
        Am J Cardiol. 2007; 100: 1370-1375
        • Tarantini G.
        • Cacciavillani L.
        • Corbetti F.
        • Ramondo A.
        • Marra M.P.
        • Bacchiega E.
        • Napodano M.
        • Bilato C.
        • Razzolini R.
        • Iliceto S.
        Duration of ischemia is a major determinant of transmurality and severe microvascular obstruction after primary angioplasty: a study performed with contrast-enhanced magnetic resonance.
        J Am Coll Cardiol. 2005; 46: 1229-1235
        • De Luca G.
        • Parodi G.
        • Sciagrà R.
        • Venditti F.
        • Bellandi B.
        • Vergara R.
        • Migliorini A.
        • Valenti R.
        • Antoniucci D.
        Time-to-treatment and infarct size in STEMI patients undergoing primary angioplasty.
        Int J Cardiol. 2013; 167: 1508-1513