Dr. C. Michael Gibson & Dr. Ginger Jiang on CELEBRATE: Pre-hospital Zalunfiban for STEMI in SnackableHealth

In this SnackableHealth discussion, Dr. C. Michael Gibson and Dr. Ginger Jiang unpack CELEBRATE—a pre-hospital strategy using zalunfiban, a subcutaneous GP IIb/IIIa inhibitor, at first medical contact for STEMI. The north star is speed: if one-third to one-half of MI deaths happen before hospital arrival, pushing potent platelet inhibition upstream could be a game-changer.

In 2,500 patients, early zalunfiban opened more arteries by cath-lab arrival and reduced a ranked composite (death, MI, stroke, stent thrombosis, heart failure, or large infarct) by ~21% via a proportional-odds framework, with ~3.5% absolute improvement in event-free survival (≈ NNT 29).

Safety leaned favorable for the hard stuff—no excess severe/life-threatening bleeding, ICH, or GI bleeds—though mild/moderate bleeds ticked up, mostly at access sites (a modern-era reality mitigated by widespread radial access). A pragmatic kicker: unlike legacy agents (eptifibatide/tirofiban), zalunfiban isn’t renally cleared and is subQ, opening the door to at-home initiation in the future. Net-net: earlier flow, smaller infarcts, fewer thrombotic complications; a manageable bleed tax; and a deployment model that meets patients where events actually start—outside the hospital. That’s high-yield execution with real-world operational fit.