Zalunfiban at First Medical Contact for ST-Elevation Myocardial
Infarction

J 2025

Zalunfiban at First Medical Contact for ST-Elevation Myocardial Infarction

VAN'T HOF, A W J; C M GIBSON; S A O F RIKKEN; J L JANUZZI; C B GRANGER et al.

Základní údaje

Originální název

Zalunfiban at First Medical Contact for ST-Elevation Myocardial Infarction

Autoři

VAN'T HOF, A W J; C M GIBSON; S A O F RIKKEN; J L JANUZZI; C B GRANGER; A. VAN BEURDEN; S. RASOUL; L. RUITERS; J. VAINER; A. VERBURG; F. ARSLAN; J W JUKEMA; M. DURIEUX; J. POLAD; R. VAN VLIET; B J L VAN DEN BRANDEN; M. MAGRO; W. REMKES; J. BEELEN; R. HERMANIDES; R. TOLSMA; M. GOSSELINK; D. VINEREANU; V. CHIONCEL; T P VAN DE HOEF; R. BOOMARS; K E ARKENBOUT; G K VAN HOUWELINGEN; G. HENGSTMAN; H. HVAN DE WETERING; R. PISTERS; Petr KALA; B. MERKELY; P. ECOLLAN; F. LAPOSTOLLE; R P GIUGLIANO; R C WELSH; M. LEVY; A. ARIAS-MENDOZA; N. BARON; D. COCIORVA; J. WITTES; E F UNGER; B S COLLER; J M TEN BERG a G. MONTALESCOT

Vydání

NEJM EVIDENCE, WALTHAM, MASSACHUSETTS MEDICAL SOC, 2025, 2766-5526

Další údaje

Jazyk

angličtina

Typ výsledku

Článek v odborném periodiku

Obor

30201 Cardiac and Cardiovascular systems

Stát vydavatele

Spojené státy

Utajení

není předmětem státního či obchodního tajemství

Odkazy

URL

Označené pro přenos do RIV

Ano

Kód RIV

RIV/00216224:14110/25:00143850

Organizační jednotka

Lékařská fakulta

Klíčová slova anglicky

ST-elevation myocardial infarction; zalunfiban; first medical contact; antiplatelet therapy; early pharmacologic intervention

Štítky

14110211

Příznaky

Mezinárodní význam, Recenzováno

Změněno: 3. 3. 2026 12:53, Mgr. Tereza Miškechová

Anotace

V originále

Background Zalunfiban is a glycoprotein IIb/IIIa (integrin alpha IIb beta 3) inhibitor designed for subcutaneous administration on first medical contact with patients with suspected ST-segment elevation myocardial infarction (STEMI). Methods An international, double-blind, placebo-controlled trial randomly assigned patients with STEMI in a 1:1:1 ratio to receive a single subcutaneous injection of zalunfiban (0.11 mg/kg or 0.13 mg/kg) or placebo. The primary efficacy end point was a hierarchical proportional odds model ranking seven end points from worst to best: all-cause death, stroke, recurrent myocardial infarction, acute stent thrombosis, new-onset or rehospitalization for heart failure, larger infarct size, or no end point through 30 days. The primary safety end point was the occurrence of severe or life-threatening bleeding as per the global use of strategies to open occluded coronary arteries (GUSTO) criteria. Results The trial randomly assigned 2467 patients (853 to zalunfiban 0.11 mg/kg, 818 to zalunfiban 0.13 mg/kg, and 796 to placebo). The primary efficacy end point was significantly improved by zalunfiban (adjusted odds ratio 0.79; 95% confidence interval, 0.65 to 0.98; P=0.028). GUSTO severe bleeding was similar between those who received zalunfiban versus placebo (1.2% vs. 0.8%; P=0.40), but GUSTO mild to moderate bleeding was increased (6.4% vs. 2.5%; P<0.001). Angiography showed faster coronary blood flow with zalunfiban versus placebo (corrected frame count of the infarct-related artery 109 [interquartile range 35 to 176] vs. 176 [interquartile range 40 to 176]; P=0.012). Conclusions In patients with STEMI, zalunfiban administered at first medical contact significantly improved preintervention infarct-related patency and reduced the likelihood of a worse 30-day multicomponent hierarchical clinical end point. Zalunfiban was not associated with increased severe or life-threatening bleeding but was associated with increased mild to moderate bleeding.

Citovat

@article{2558048,
   author = {van't Hof, A W J and Gibson, C M and Rikken, S A O F and Januzzi, J L and Granger, C B and van Beurden, A. and Rasoul, S. and Ruiters, L. and Vainer, J. and Verburg, A. and Arslan, F. and Jukema, J W and Durieux, M. and Polad, J. and van Vliet, R. and van den Branden, B J L and Magro, M. and Remkes, W. and Beelen, J. and Hermanides, R. and Tolsma, R. and Gosselink, M. and Vinereanu, D. and Chioncel, V. and van de Hoef, T P and Boomars, R. and Arkenbout, K E and van Houwelingen, G K and Hengstman, G. and Hvan de Wetering, H. and Pisters, R. and Kala, Petr and Merkely, B. and Ecollan, P. and Lapostolle, F. and Giugliano, R P and Welsh, R C and Levy, M. and AriasandMendoza, A. and Baron, N. and Cociorva, D. and Wittes, J. and Unger, E F and Coller, B S and ten Berg, J M and Montalescot, G.},
   article_location = {WALTHAM},
   article_number = {1},
   doi = {https://doi.org/10.1056/EVIDoa2500268},
   keywords = {ST-elevation myocardial infarction; zalunfiban; first medical contact; antiplatelet therapy; early pharmacologic intervention},
   language = {eng},
   issn = {2766-5526},
   journal = {NEJM EVIDENCE},
   title = {Zalunfiban at First Medical Contact for ST-Elevation Myocardial Infarction},
   url = {https://evidence.nejm.org/doi/10.1056/EVIDoa2500268},
   volume = {5},
   year = {2025}
}

TY  - JOUR
ID  - 2558048
AU  - van't Hof, A W J - Gibson, C M - Rikken, S A O F - Januzzi, J L - Granger, C B - van Beurden, A. - Rasoul, S. - Ruiters, L. - Vainer, J. - Verburg, A. - Arslan, F. - Jukema, J W - Durieux, M. - Polad, J. - van Vliet, R. - van den Branden, B J L - Magro, M. - Remkes, W. - Beelen, J. - Hermanides, R. - Tolsma, R. - Gosselink, M. - Vinereanu, D. - Chioncel, V. - van de Hoef, T P - Boomars, R. - Arkenbout, K E - van Houwelingen, G K - Hengstman, G. - Hvan de Wetering, H. - Pisters, R. - Kala, Petr - Merkely, B. - Ecollan, P. - Lapostolle, F. - Giugliano, R P - Welsh, R C - Levy, M. - Arias-Mendoza, A. - Baron, N. - Cociorva, D. - Wittes, J. - Unger, E F - Coller, B S - ten Berg, J M - Montalescot, G.
PY  - 2025
TI  - Zalunfiban at First Medical Contact for ST-Elevation Myocardial Infarction
JF  - NEJM EVIDENCE
VL  - 5
IS  - 1
SP  - 1-10
EP  - 1-10
PB  - MASSACHUSETTS MEDICAL SOC
SN  - 27665526
KW  - ST-elevation myocardial infarction
KW  - zalunfiban
KW  - first medical contact
KW  - antiplatelet therapy
KW  - early pharmacologic intervention
UR  - https://evidence.nejm.org/doi/10.1056/EVIDoa2500268
N2  - Background Zalunfiban is a glycoprotein IIb/IIIa (integrin alpha IIb beta 3) inhibitor designed for subcutaneous administration on first medical contact with patients with suspected ST-segment elevation myocardial infarction (STEMI). Methods An international, double-blind, placebo-controlled trial randomly assigned patients with STEMI in a 1:1:1 ratio to receive a single subcutaneous injection of zalunfiban (0.11 mg/kg or 0.13 mg/kg) or placebo. The primary efficacy end point was a hierarchical proportional odds model ranking seven end points from worst to best: all-cause death, stroke, recurrent myocardial infarction, acute stent thrombosis, new-onset or rehospitalization for heart failure, larger infarct size, or no end point through 30 days. The primary safety end point was the occurrence of severe or life-threatening bleeding as per the global use of strategies to open occluded coronary arteries (GUSTO) criteria. Results The trial randomly assigned 2467 patients (853 to zalunfiban 0.11 mg/kg, 818 to zalunfiban 0.13 mg/kg, and 796 to placebo). The primary efficacy end point was significantly improved by zalunfiban (adjusted odds ratio 0.79; 95% confidence interval, 0.65 to 0.98; P=0.028). GUSTO severe bleeding was similar between those who received zalunfiban versus placebo (1.2% vs. 0.8%; P=0.40), but GUSTO mild to moderate bleeding was increased (6.4% vs. 2.5%; P<0.001). Angiography showed faster coronary blood flow with zalunfiban versus placebo (corrected frame count of the infarct-related artery 109 [interquartile range 35 to 176] vs. 176 [interquartile range 40 to 176]; P=0.012). Conclusions In patients with STEMI, zalunfiban administered at first medical contact significantly improved preintervention infarct-related patency and reduced the likelihood of a worse 30-day multicomponent hierarchical clinical end point. Zalunfiban was not associated with increased severe or life-threatening bleeding but was associated with increased mild to moderate bleeding.
ER  -

Přehled o publikaci