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Prehospital high-dose tirofiban in patients undergoing primary percutaneous intervention. The AGIR-2 study

Carlos El Khoury1, Pierre-Yves Dubien, Catherine Mercier

  • 1RESCUE Network, Hussel Hospital, Vienne, France.

Archives of Cardiovascular Diseases
|July 13, 2010
PubMed

Insights

Prehospital tirofiban initiation did not improve outcomes for ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. Early treatment with glycoprotein IIb/IIIa inhibitors showed no significant benefit when given before the catheterization lab.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Emergency Medicine

Background:

  • Early administration of glycoprotein IIb/IIIa inhibitors benefits ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI).
  • The impact of prehospital tirofiban on top of a 600 mg clopidogrel loading dose is not well-established.

Purpose of the Study:

  • To evaluate the efficacy of prehospital high-dose bolus tirofiban compared to catheterization laboratory administration in STEMI patients undergoing primary PCI.
  • To assess the impact on initial infarct-related artery flow and ST-segment resolution.

Main Methods:

  • A multicenter, randomized controlled trial involving 320 STEMI patients.
  • Patients received high-dose tirofiban either prehospital (ambulance) or in the catheterization laboratory.
  • Primary endpoint: TIMI flow grade 2-3 at initial angiography; Secondary endpoints: ST-segment resolution, peak troponin I.

Main Results:

  • Tirofiban was administered an average of 48 minutes earlier in the prehospital group.
  • No significant difference in initial TIMI 2-3 flow (44.2% vs. 39.7%, p=0.45) between groups.
  • No significant differences observed in post-PCI angiography, peak troponin levels, or complete ST-segment resolution (52.6% vs. 55.4%, p=0.32).

Conclusions:

  • Prehospital initiation of high-dose tirofiban did not significantly improve initial TIMI flow or ST-segment resolution in STEMI patients undergoing primary PCI.
  • The findings suggest that early administration of tirofiban in the prehospital setting does not offer a significant advantage over catheterization laboratory initiation for these specific outcomes.
Abstract

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