ST-segment resolution with bivalirudin versus heparin and routine glycoprotein IIb/IIIa inhibitors started in the ambulance in ST-segment elevation myocardial infarction patients transported for primary percutaneous coronary intervention: The EUROMAX ST-segment resolution substudy
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ST-segment resolution with bivalirudin versus heparin and routine glycoprotein IIb/IIIa inhibitors started in the ambulance in ST-segment elevation myocardial infarction patients transported for primary percutaneous coronary intervention: The EUROMAX ST-segment resolution substudy. / Van't Hof, Arnoud; Giannini, Francesco; Ten Berg, Jurrien; Tolsma, Rudolf; Clemmensen, Peter; Bernstein, Debra; Coste, Pierre; Goldstein, Patrick; Zeymer, Uwe; Hamm, Christian; Deliargyris, Efthymios; Steg, Philippe G.
in: EUR HEART J-ACUTE CA, Jahrgang 6, Nr. 5, 08.2017, S. 404-411.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - ST-segment resolution with bivalirudin versus heparin and routine glycoprotein IIb/IIIa inhibitors started in the ambulance in ST-segment elevation myocardial infarction patients transported for primary percutaneous coronary intervention: The EUROMAX ST-segment resolution substudy
AU - Van't Hof, Arnoud
AU - Giannini, Francesco
AU - Ten Berg, Jurrien
AU - Tolsma, Rudolf
AU - Clemmensen, Peter
AU - Bernstein, Debra
AU - Coste, Pierre
AU - Goldstein, Patrick
AU - Zeymer, Uwe
AU - Hamm, Christian
AU - Deliargyris, Efthymios
AU - Steg, Philippe G
PY - 2017/8
Y1 - 2017/8
N2 - BACKGROUND: Myocardial reperfusion after primary percutaneous coronary intervention (PCI) can be assessed by the extent of post-procedural ST-segment resolution. The European Ambulance Acute Coronary Syndrome Angiography (EUROMAX) trial compared pre-hospital bivalirudin and pre-hospital heparin or enoxaparin with or without GPIIb/IIIa inhibitors (GPIs) in primary PCI. This nested substudy was performed in centres routinely using pre-hospital GPI in order to compare the impact of randomized treatments on ST-resolution after primary PCI.METHODS: Residual cumulative ST-segment deviation on the single one hour post-procedure electrocardiogram (ECG) was assessed by an independent core laboratory and was the primary endpoint. It was calculated that 762 evaluable patients were needed to show non-inferiority (85% power, alpha 2.5%) between randomized treatments.RESULTS: A total of 871 participated with electrocardiographic data available in 824 patients (95%). Residual ST-segment deviation one hour after PCI was 3.8±4.9 mm versus 3.9±5.2 mm for bivalirudin and heparin+GPI, respectively ( p=0.0019 for non-inferiority). Overall, there were no differences between randomized treatments in any measures of ST-segment resolution either before or after the index procedure.CONCLUSIONS: Pre-hospital treatment with bivalirudin is non-inferior to pre-hospital heparin + GPI with regard to residual ST-segment deviation or ST-segment resolution, reflecting comparable myocardial reperfusion with the two strategies.
AB - BACKGROUND: Myocardial reperfusion after primary percutaneous coronary intervention (PCI) can be assessed by the extent of post-procedural ST-segment resolution. The European Ambulance Acute Coronary Syndrome Angiography (EUROMAX) trial compared pre-hospital bivalirudin and pre-hospital heparin or enoxaparin with or without GPIIb/IIIa inhibitors (GPIs) in primary PCI. This nested substudy was performed in centres routinely using pre-hospital GPI in order to compare the impact of randomized treatments on ST-resolution after primary PCI.METHODS: Residual cumulative ST-segment deviation on the single one hour post-procedure electrocardiogram (ECG) was assessed by an independent core laboratory and was the primary endpoint. It was calculated that 762 evaluable patients were needed to show non-inferiority (85% power, alpha 2.5%) between randomized treatments.RESULTS: A total of 871 participated with electrocardiographic data available in 824 patients (95%). Residual ST-segment deviation one hour after PCI was 3.8±4.9 mm versus 3.9±5.2 mm for bivalirudin and heparin+GPI, respectively ( p=0.0019 for non-inferiority). Overall, there were no differences between randomized treatments in any measures of ST-segment resolution either before or after the index procedure.CONCLUSIONS: Pre-hospital treatment with bivalirudin is non-inferior to pre-hospital heparin + GPI with regard to residual ST-segment deviation or ST-segment resolution, reflecting comparable myocardial reperfusion with the two strategies.
KW - Abciximab
KW - Aged
KW - Ambulances
KW - Antibodies, Monoclonal/administration & dosage
KW - Anticoagulants/administration & dosage
KW - Antithrombins/administration & dosage
KW - Coronary Angiography
KW - Dose-Response Relationship, Drug
KW - Electrocardiography/drug effects
KW - Emergency Medical Services/methods
KW - Female
KW - Follow-Up Studies
KW - Heparin/administration & dosage
KW - Hirudins/administration & dosage
KW - Humans
KW - Immunoglobulin Fab Fragments/administration & dosage
KW - Male
KW - Middle Aged
KW - Peptide Fragments/administration & dosage
KW - Percutaneous Coronary Intervention
KW - Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors
KW - Recombinant Proteins/administration & dosage
KW - Retrospective Studies
KW - ST Elevation Myocardial Infarction/diagnosis
KW - Time Factors
KW - Transportation of Patients
KW - Treatment Outcome
U2 - 10.1177/2048872615598633
DO - 10.1177/2048872615598633
M3 - SCORING: Journal article
C2 - 26250825
VL - 6
SP - 404
EP - 411
JO - EUR HEART J-ACUTE CA
JF - EUR HEART J-ACUTE CA
SN - 2048-8726
IS - 5
ER -
