Ingo Eitel, Roza Saraei, Dominik Jurczyk, Andreas Fach, Rainer Hambrecht, Harm Wienbergen, Christian Frerker, Tobias Schmidt, Abdelhakim Allali, Alexander Joost, Christoph Marquetand, Thomas Kurz, Philip Haaf, Gregor Fahrni, Christian Mueller, Steffen Desch, Holger Thiele, Thomas Stiermaier
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The primary endpoint was infarct size [percentage of left ventricular (LV) mass assessed by cardiac magnetic resonance (CMR). Secondary endpoints included CMR-derived MVO and 30-day adverse clinical events. The trial is registered with ClinicalTrials.gov: NCT02739711.</p><p><strong>Results: </strong>The population was predominantly male (76.7%) with a median age of 66 years and ST-elevation myocardial infarction in 73.3% of patients. Clinical and angiographic characteristics were well balanced between the cohorts. Patients in the treatment group (n = 62) received eptifibatide (n = 41) or tirofiban (n = 21). Infarct size assessed by CMR imaging was similar in both study groups [25.4% of LV mass (%LV) vs. 25.2%LV; P = .386]. However, the number of patients with evidence of CMR-derived MVO (74.5% vs. 92.2%; P = .017) and the extent of MVO (2.1%LV vs. 3.4%LV; P = .025) were significantly reduced in the GP IIb/IIIa inhibitor group compared with controls. Thirty-day outcome showed an increased bleeding risk after GP IIb/IIIa inhibitor administration restricted to non-life-threatening bleedings (22.6% vs. 6.9%; P = .016) without differences in all-cause mortality (4.8% vs. 3.4%; P = .703).</p><p><strong>Conclusions: </strong>Bailout GP IIb/IIIa inhibition in AMI patients with angiographic MVO failed to reduce the primary endpoint infarct size but decreased CMR-derived MVO and led to an increase in non-fatal bleeding events.</p>","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":" ","pages":"5058-5067"},"PeriodicalIF":37.6000,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Glycoprotein IIb/IIIa inhibitors in acute myocardial infarction and angiographic microvascular obstruction: the REVERSE-FLOW trial.\",\"authors\":\"Ingo Eitel, Roza Saraei, Dominik Jurczyk, Andreas Fach, Rainer Hambrecht, Harm Wienbergen, Christian Frerker, Tobias Schmidt, Abdelhakim Allali, Alexander Joost, Christoph Marquetand, Thomas Kurz, Philip Haaf, Gregor Fahrni, Christian Mueller, Steffen Desch, Holger Thiele, Thomas Stiermaier\",\"doi\":\"10.1093/eurheartj/ehae587\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and aims: </strong>Glycoprotein (GP) IIb/IIIa inhibitors are recommended in acute myocardial infarction (AMI) for bailout treatment in case of angiographic microvascular obstruction (MVO), also termed no-reflow phenomenon, after percutaneous coronary intervention (PCI) with, however, lacking evidence (class IIa, level C).</p><p><strong>Methods: </strong>The investigator-initiated, international, multicentre REVERSE-FLOW trial randomized 120 patients with AMI and thrombolysis in myocardial infarction flow grade ≤ 2 after primary PCI to optimal medical therapy with or without GP IIb/IIIa inhibitor. 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引用次数: 0
摘要
背景和目的：糖蛋白（GP）Ⅱb/Ⅲa抑制剂被推荐用于急性心肌梗死（AMI）经皮冠状动脉介入治疗（PCI）后出现血管造影微血管阻塞（MVO）（也称无回流现象）时的救助治疗，但缺乏证据（IIa级，C级）：由研究者发起的国际多中心 REVERSE-FLOW 试验将 120 名初级 PCI 后血流分级≤2 的急性心肌梗死患者随机分为使用或不使用 GP IIb/IIIa 抑制剂的最佳药物疗法。主要终点是心脏磁共振（CMR）评估的梗死面积（%LV）。次要终点包括 CMR 导出的 MVO 和 30 天不良临床事件。该试验已在 ClinicalTrials.gov 注册：NCT02739711.Results：研究对象主要为男性（76.7%），中位年龄为 66 岁，73.3% 的患者为 ST 段抬高型心肌梗死。两组患者的临床和血管造影特征非常均衡。治疗组（62 例）患者接受了依菲巴特（41 例）或替罗非班（21 例）治疗。两个研究组通过 CMR 成像评估的梗死面积相似（占左心室容积 [LV] 的 25.4% vs. 25.2%LV；P=0.386）。然而，与对照组相比，GP IIb/IIIa 抑制剂组中有 CMR 衍生 MVO 证据的患者人数（74.5% vs. 92.2%；p=0.017）和 MVO 的范围（2.1%LV vs. 3.4%LV；p=0.025）显著减少。30天的结果显示，服用GP IIb/IIIa抑制剂后出血风险增加，但仅限于不危及生命的出血（22.6% vs. 6.9%；p=0.016），全因死亡率（4.8% vs. 3.4%；p=0.703）没有差异：结论：对有血管造影 MVO 的急性心肌梗死患者进行保外 GP IIb/IIIa 抑制未能缩小主要终点梗死面积，但减少了 CMR 衍生的 MVO，并导致非致命性出血事件增加。
Glycoprotein IIb/IIIa inhibitors in acute myocardial infarction and angiographic microvascular obstruction: the REVERSE-FLOW trial.
Background and aims: Glycoprotein (GP) IIb/IIIa inhibitors are recommended in acute myocardial infarction (AMI) for bailout treatment in case of angiographic microvascular obstruction (MVO), also termed no-reflow phenomenon, after percutaneous coronary intervention (PCI) with, however, lacking evidence (class IIa, level C).
Methods: The investigator-initiated, international, multicentre REVERSE-FLOW trial randomized 120 patients with AMI and thrombolysis in myocardial infarction flow grade ≤ 2 after primary PCI to optimal medical therapy with or without GP IIb/IIIa inhibitor. The primary endpoint was infarct size [percentage of left ventricular (LV) mass assessed by cardiac magnetic resonance (CMR). Secondary endpoints included CMR-derived MVO and 30-day adverse clinical events. The trial is registered with ClinicalTrials.gov: NCT02739711.
Results: The population was predominantly male (76.7%) with a median age of 66 years and ST-elevation myocardial infarction in 73.3% of patients. Clinical and angiographic characteristics were well balanced between the cohorts. Patients in the treatment group (n = 62) received eptifibatide (n = 41) or tirofiban (n = 21). Infarct size assessed by CMR imaging was similar in both study groups [25.4% of LV mass (%LV) vs. 25.2%LV; P = .386]. However, the number of patients with evidence of CMR-derived MVO (74.5% vs. 92.2%; P = .017) and the extent of MVO (2.1%LV vs. 3.4%LV; P = .025) were significantly reduced in the GP IIb/IIIa inhibitor group compared with controls. Thirty-day outcome showed an increased bleeding risk after GP IIb/IIIa inhibitor administration restricted to non-life-threatening bleedings (22.6% vs. 6.9%; P = .016) without differences in all-cause mortality (4.8% vs. 3.4%; P = .703).
Conclusions: Bailout GP IIb/IIIa inhibition in AMI patients with angiographic MVO failed to reduce the primary endpoint infarct size but decreased CMR-derived MVO and led to an increase in non-fatal bleeding events.
期刊介绍：
The European Heart Journal is a renowned international journal that focuses on cardiovascular medicine. It is published weekly and is the official journal of the European Society of Cardiology. This peer-reviewed journal is committed to publishing high-quality clinical and scientific material pertaining to all aspects of cardiovascular medicine. It covers a diverse range of topics including research findings, technical evaluations, and reviews. Moreover, the journal serves as a platform for the exchange of information and discussions on various aspects of cardiovascular medicine, including educational matters.
In addition to original papers on cardiovascular medicine and surgery, the European Heart Journal also presents reviews, clinical perspectives, ESC Guidelines, and editorial articles that highlight recent advancements in cardiology. Additionally, the journal actively encourages readers to share their thoughts and opinions through correspondence.
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