The golden hour of prehospital reperfusion with triple antiplatelet therapy: A sub-analysis from the Ongoing Tirofiban in Myocardial Evaluation 2 (On-TIME 2) trial early initiation of triple antiplatelet therapy

Heestermans, Ton; Hof, Arnoud W J van ‘t; Berg, Jürrien M. ten; Werkum, Jochem W. van; Boersma, Eric; Mosterd, Arend; Stella, Pieter R.; Zoelen, Arthur B. van; Gosselink, A T Marcel; Kochman, Wacław; Dill, Thorsten; Koopmans, Petra C.; Houwelingen, Gert van; Zijlstra, Felix; Hamm, Christian W.

doi:10.1016/j.ahj.2010.08.039

Cited by 37 publications

(25 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the case of at-hospital delays, the useful predictors were whether patients were transported to the hospital in an ambulance (p≤0.001), and fear of embarrassment (p=0.001). Similar predictors of hospital delays were reported by McKee et al 25 Aggressive treatment in the first 2 hours, post symptom onset and preferably within the 'golden hour', 26 leads to a much lower mortality and reduced instances of disease complications. However, in our study, less than 30% of the patients were treated within 2 hours.…”

Section: Discussionsupporting

confidence: 62%

Pre-hospital care in stable patients with acute coronary syndrome: Factors and predictors of pre-hospital delays in a tertiary public health institute

Bahall

Legall

2017

Int J Community Med Public Health

View full text Add to dashboard Cite

Background: Incidences of pre-hospital delays (PHDs) remain high and affect the outcomes in acute coronary syndrome (ACS) patients. This study explored the factors associated with, and the predictors of PHD in ACS patients. Methods: Data were collected through interviews and the examination of the hospital records of 299 ACS patients admitted to a hospital between 1 December 2014 and 28 February 2015. Results: The patients were primarily female, and their mean age was 60.9±12.09 years. The mean PHD was 7.5±6.6 hours; this comprised mean delay from symptoms onset to departure, mean travel time from departure time to intermediate care facility, mean length of stay at intermediate care facility, and mean travel time from an intermediate care facility to hospital. The factors associated with delays were ignoring of symptoms (38.8%), indecisiveness and reluctance to seek treatment (16.7%), self-medication (35.5%), being unconvinced that the symptoms were serious (61.2%), and waiting for a worsening of pain (29.1%). The predictors of PHDs were ‘marital status’, ‘fear of having a heart attack’, ‘believing that the symptoms were self-limiting’, and ‘seeking intermediate care’. The predictors of hospital delays were ‘AM or PM occurrence of symptom’, ‘shortness of breath’, ‘having hypertension’, and ‘previous ischaemic heart disease’.Conclusions: Patient delays were high in the case of ACS, but utilization of an intermediate healthcare facility more than doubled the PHD. About two-thirds of the patients had a PHD that exceeded 2 hours.

show abstract

Section: Discussionsupporting

confidence: 62%

Pre-hospital care in stable patients with acute coronary syndrome: Factors and predictors of pre-hospital delays in a tertiary public health institute

Bahall

Legall

2017

Int J Community Med Public Health

View full text Add to dashboard Cite

show abstract

“…A similar sub-analysis from the On-TIME 2 trial has clearly shown larger benefits from early, upstream initiation of high-dose tirofiban, in patients presenting earlier [241,242]. The difference in thrombus composition across different time intervals from symptoms onset can certainly contribute to explain the findings observed in the current study.…”

Section: Upstream Therapymentioning

confidence: 42%

Platelet GP IIb-IIIa Receptor Antagonists in Primary Angioplasty: Back to the Future

Luca

Savonitto

Hof

et al. 2015

Drugs

View full text Add to dashboard Cite

Coronary artery disease and acute myocardial infarction still represent the leading cause of mortality in developed countries. Therefore, great efforts have been made in the last decades to improve reperfusion strategies and adjunctive antithrombotic therapies. In fact, despite optimal epicardial recanalisation, a large proportion of patients still experience impaired reperfusion and in-stent thrombosis. The adjunctive use of glycoprotein (GP) IIb-IIIa inhibitors may certainly contribute in the reduction of such complications, especially when administered in the early phase of infarction. In fact, in this phase a larger platelet composition of the thrombus and the presence of a larger amount of viable myocardium, as compared to a delayed phase, may increase the benefits from this therapy and counterbalance the potential higher risk of bleeding. A large body of evidence has been accumulated on the benefits from GP IIb-IIIa inhibitors in terms of prevention of stent thrombosis, and benefits in mortality, especially among high-risk patients and as upstream strategy. Therefore, based on current available data, GP IIb-IIIa inhibitors can be recommended as early as possible (upstream strategy) among high-risk patients, such as those with advanced Killip class or anterior myocardial infarction (MI), and those presenting within the first three hours. Even though it is not universally accepted, in our opinion this strategy should be implemented in a pre-hospital setting (in ambulance) or at first hospital admission (Emergency Room or Coronary Care Unit, irrespective of whether they are in the spoke or hub hospitals). Peri-procedural intracoronary administration of GP IIb-IIIa inhibitors has not provided additional benefits as compared to intravenous administration and therefore cannot be recommended. Even though the vast majority of trials have been conducted with abciximab, several meta-analyses comparing small molecules (mainly high-dose tirofiban rather than eptifibatide) versus abciximab showed similar angiographic and clinical results between the molecules. Several recent investigations and meta-analyses have documented the higher risk of stent thrombosis associated with bivalirudin as compared to unfractionated heparin (UFH). Being that these results are independent from the use of GP IIb-IIIa inhibitors, UFH should still remain the anticoagulation therapy of choice in ST-segment elevation myocardial infarction (STEMI) patients. Minimisation of bleeding complications by extensive use of the radial approach, in the setting of STEMI, may further contribute to the adoption of a more aggressive antithrombotic and antiplatelet therapy incorporating the use of GP IIb-IIIa inhibitors. The establishment of dedicated networks for STEMI, and the large STEMI campaign, will certainly contribute to increase the proportion of patients presenting at first medical contact within the early phase (3 h) of infarction and therefore highly suitable for a more aggressive pharmacoinvasive approach with upstream administration of GP IIb-II...

show abstract

“…Although quite a common phenomenon in patients who, after initial diagnosis of STEMI and subsequent pharmacological intervention, are transferred to PCI-capable centers, its clinical relevance has not been widely explored. In the post-hoc analysis of the On-TIME 2 trial, a 16.6% incidence of total pre-angiography STSR was noted with a higher rate in patients with a short time delay (b45 min) from symptom onset to revascularization and who were pretreated with 3 antiplatelet agents [11]). A 23.9% rate of pre-angiography STSR was observed in the MONAMI Study [12].…”

Section: Discussionmentioning

confidence: 96%

“…Studies on pharmacologically induced pre-hospital reperfusion in STEMI patients undergoing primary PCI have shown a high incidence, between 16.6% and 23.9%, of pre-angiography total STSR [11][12][13]. Although the resolution of ST-segment elevations is quite a common phenomenon in STEMI patients who, after initial pharmacologic intervention, are transferred to PCI-capable centers, its clinical relevance has not yet been established.…”

Section: Introductionmentioning

confidence: 97%

Pre-angiography total ST-segment resolution is not a reliable predictor of an open infarct-related artery

Prech

Bartela²,

Araszkiewicz

et al. 2014

European Journal of Internal Medicine

View full text Add to dashboard Cite

The golden hour of prehospital reperfusion with triple antiplatelet therapy: A sub-analysis from the Ongoing Tirofiban in Myocardial Evaluation 2 (On-TIME 2) trial early initiation of triple antiplatelet therapy

Cited by 37 publications

References 19 publications

Pre-hospital care in stable patients with acute coronary syndrome: Factors and predictors of pre-hospital delays in a tertiary public health institute

Pre-hospital care in stable patients with acute coronary syndrome: Factors and predictors of pre-hospital delays in a tertiary public health institute

Platelet GP IIb-IIIa Receptor Antagonists in Primary Angioplasty: Back to the Future

Pre-angiography total ST-segment resolution is not a reliable predictor of an open infarct-related artery

Contact Info

Product

Resources

About