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Study supports in-ambulance STEMI treatment


Early, in-ambulance treatment with antiplatelet medicine AGGRASTAT (tirofiban HCL), in addition to the standard combined treatment of aspirin, heparin and clopidogrel, significantly improves the results of primary coronary angioplasty (PCI) in patients with ST-elevated myocardial infarction (STEMI). These findings were presented today at the Annual European Society of Cardiology Congress in Munich, Germany.

Data from the Ongoing Tirofiban in Myocardial Infarction Evaluation (On-TIME) 2 trial in showed that treatment with AGGRASTAT – a glycoprotein IIb/IIIa inhibitor – in addition to the standard triple treatment package, significantly reduced the incidence of residual ST-segment deviation versus placebo or no AGGRASTAT after PCI in STEMI patients. The ST segment in the ECG is a good marker of vessel occlusion and closely linked to the outcome of the patients with myocardial infarction.

“These results are significant in that they address the two key unknowns in this area. Firstly, the value of early intervention with glycoprotein IIb/IIIa inhibitors on top of the standard treatment of aspirin, heparin and clopidogrel in STEMI patients; and secondly, the most effective timing of that intervention,” said Dr Arnoud van’t Hof, Department of Cardiology, Isala Klinieken, Zwolle, Netherlands and principal investigator.

“The data from On-TIME 2 shows the importance of diagnosing STEMI at the earliest possible point in the cascade of events that lead to a heart attack, thereby allowing for the initiation of antithrombotic and triple antiplatelet therapy including AGGRASTAT as early as the ambulance setting, thereby fully optimising the outcome for the patient.”

The data from the double-blind placebo control trial was published recently in The Lancet, with an accompanying commentary from independent expert, Dr Gilles Montalescot,  stating, “On-TIME 2 tells us more than the benefit of AGGRASTAT in pre-PCI. The study reveals that high-dose clopidogrel is not effective enough and confirms the need for fast and strong platelet inhibition.”


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