Optimizing antithrombotic therapy in the prehospital phase of ST-segment elevation myocardial infarction (STEMI) remains challenging due to the delayed onset of action of P2Y12 inhibitors. Zalunfiban, a rapid-acting subcutaneous GP IIb/IIIa inhibitor (90% platelet inhibition within 15 minutes and a half-life of approximately one hour), has emerged as a strategy to achieve early platelet inhibition.
The CELEBRATE trial included 2,467 patients with ECG-suspected STEMI within ≤4 hours of symptom onset, randomized to receive subcutaneous zalunfiban or placebo at the first medical contact (home, ambulance, or hospital). The primary endpoint was a hierarchical composite of cardiovascular events at 30 days.
CELEBRATE Trial: Prehospital Zalunfiban Accelerates ST-Segment Resolution and Early Reperfusion in STEMI
In this prespecified analysis, zalunfiban demonstrated a significant improvement in ST-segment resolution prior to angiography (40.5% vs 33.1%; p=0.0009), suggesting earlier reperfusion. The drug was administered in 87% of cases in the prehospital setting (ambulance or home).
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Furthermore, pre-angiography ST-segment resolution was associated with better angiographic outcomes (higher initial TIMI 2–3 flow and lower thrombus grade 5) and improved clinical outcomes (adjusted OR 3.02; 95% CI 2.37–3.84). Clinically, the proportion of patients free from cardiovascular events was higher with zalunfiban (13.3% vs 9.8%), representing an absolute risk reduction of 3.5% (NNT 29; p=0.016).
The benefit was more pronounced in patients with longer delays to angiography, suggesting that this strategy could “buy time” in scenarios where access to the catheterization laboratory is delayed.
Conclusion
Prehospital administration of zalunfiban improved early ST-segment resolution and was associated with better clinical outcomes, positioning this strategy as a promising approach to optimize early reperfusion in STEMI patients.
Presentado por Arnoud W. J. van ’t Hof en Acute Cardiovascular Care Congress 2026, Lisboa, Portugal, 20-21 de marzo de 2026.
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