The effect of zalunfiban on high sensitivity cardiac troponin and the association with clinical outcomes in patients with STEMI.

James L Januzzi; C Michael Gibson; Gerald Chi; Barry S Coller; Christopher B Granger; Gilles Montalescot; Sem A O F Rikken; Ashley Verburg; Jurrien M Ten Berg; Arnoud W J van 't Hof; CELEBRATE Investigators

doi:10.1016/j.ahj.2026.107513

PubMed · 42303064

The effect of zalunfiban on high sensitivity cardiac troponin and the association with clinical outcomes in patients with STEMI.

James L Januzzi·C Michael Gibson·Gerald Chi·Barry S Coller·Christopher B Granger·Gilles Montalescot·Sem A O F Rikken·Ashley Verburg·Jurrien M Ten Berg·Arnoud W J van 't Hof·CELEBRATE Investigators

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Abstract

BACKGROUND: Among individuals with ST-segment elevation myocardial infarction (STEMI), a single subcutaneous injection of the short-acting glycoprotein IIb/IIIa receptor blocker antagonist zalunfiban at first medical contact significantly improved the primary outcome including clinical endpoints. The impact of zalunfiban on Myocardial Infarction (MI) size and association with downstream outcomes remains unclear. METHODS: In a prespecified analysis, we studied results among study participants treated with 2 doses of zalunfiban who had core laboratory measurements concentrations of hs-cTnT. RESULTS: More elevated hs-cTnT concentrations at presentation were associated with less resolution of ST deviation (P = .006) and more frequent Q wave development (P < .001). At coronary angiography more elevated hs-cTnT at presentation was associated with higher thrombus grade and worse epicardial and myocardial perfusion (all P < .05). In multivariable analyses, higher hs-cTnT concentrations at 24 hours were associated with greater adjusted risk for all-cause death (odds ratio [OR] 1.83 per log unit increase; P = .03), cardiovascular death (OR 1.83 per log unit increase; P = .03), heart failure (OR 2.74 per log unit increase; P < .001) or the composite of death and heart failure (P < .001) by 30 days. At 24 hours, those treated with zalunfiban had lower hs-cTnT compared to placebo (P = .04) and across multiples ≥ 10 to ≥ 1,000 times elevation, treatment with zalunfiban resulted in smaller hs-cTnT determined MI size. CONCLUSIONS: Among patients with STEMI, more elevated concentrations of hs-cTnT are associated with worse measures of reperfusion and higher-risk for short-term death or heart failure. A single dose of zalunfiban at first medical contact reduced MI size. TRIAL REGISTRATION: A phase 3 study of zalunfiban in subjects with ST-elevation MI (CELEBRATE); NCT04825743.

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Humans Female Male ST Elevation Myocardial Infarction Coronary Angiography Middle Aged Aged Platelet Glycoprotein GPIIb-IIIa Complex Treatment Outcome Electrocardiography Injections, Subcutaneous Platelet Aggregation Inhibitors Biomarkers Journal Article Randomized Controlled Trial Multicenter Study

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James L Januzzi, C Michael Gibson, Gerald Chi, Barry S Coller, Christopher B Granger, Gilles Montalescot, Sem A O F Rikken, Ashley Verburg, Jurrien M Ten Berg, Arnoud W J van 't Hof, CELEBRATE Investigators. 2026-06-16. The effect of zalunfiban on high sensitivity cardiac troponin and the association with clinical outcomes in patients with STEMI.. https://doi.org/10.1016/j.ahj.2026.107513

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Journal Article; Randomized Controlled Trial; Multicenter Study resource Aged subject Biomarkers subject Female subject Humans subject Injections, Subcutaneous subject Journal Article subject Male subject Middle Aged subject Multicenter Study subject Randomized controlled trials study

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