Effect of Pre-Hospital Ticagrelor During the First 24 h After Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction: The ATLANTIC-H²⁴ Analysis.

Montalescot, Gilles; van 't Hof, Arnoud W; Bolognese, Leonardo; Cantor, Warren J; Cequier, Angel; Chettibi, Mohamed; Collet, Jean-Philippe; Goodman, Shaun G; Hammett, Christopher J; Huber, Kurt; Janzon, Magnus; Lapostolle, Frédéric; Lassen, Jens Flensted; Licour, Muriel; Merkely, Béla; Salhi, Néjoua; Silvain, Johanne; Storey, Robert F; Ten Berg, Jurriën M; Tsatsaris, Anne; ... (2016). Effect of Pre-Hospital Ticagrelor During the First 24 h After Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction: The ATLANTIC-H²⁴ Analysis. JACC. Cardiovascular Interventions, 9(7), pp. 646-656. Elsevier 10.1016/j.jcin.2015.12.024

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OBJECTIVES The aim of this landmark exploratory analysis, ATLANTIC-H(24), was to evaluate the effects of pre-hospital ticagrelor during the first 24 h after primary percutaneous coronary intervention (PCI) in the ATLANTIC (Administration of Ticagrelor in the cath Lab or in the Ambulance for New ST elevation myocardial infarction to open the Coronary artery) study. BACKGROUND The ATLANTIC trial in patients with ongoing ST-segment elevation myocardial infarction showed that pre-hospital ticagrelor was safe but did not improve pre-PCI coronary reperfusion compared with in-hospital ticagrelor. We hypothesized that the effect of pre-hospital ticagrelor may not have manifested until after PCI due to the rapid transfer time (31 min). METHODS The ATLANTIC-H(24) analysis included 1,629 patients who underwent PCI, evaluating platelet reactivity, Thrombolysis In Myocardial Infarction flow grade 3, ≥ 70% ST-segment elevation resolution, and clinical endpoints over the first 24 h. RESULTS Following PCI, largest between-group differences in platelet reactivity occurred at 1 to 6 h; coronary reperfusion rates numerically favored pre-hospital ticagrelor, and the degree of ST-segment elevation resolution was significantly greater in the pre-hospital group (median, 75.0% vs. 71.4%; p = 0.049). At 24 h, the composite ischemic endpoint was lower with pre-hospital ticagrelor (10.4% vs. 13.7%; p = 0.039), as were individual endpoints of definite stent thrombosis (p = 0.0078) and myocardial infarction (p = 0.031). All endpoints except death (1.1% vs. 0.2%; p = 0.048) favored pre-hospital ticagrelor, with no differences in bleeding events. CONCLUSIONS The effects of pre-hospital ticagrelor became apparent after PCI, with numerical differences in platelet reactivity and immediate post-PCI reperfusion, associated with reductions in ischemic endpoints, over the first 24 h, whereas there was a small excess of mortality. (Administration of Ticagrelor in the cath Lab or in the Ambulance for New ST elevation myocardial infarction to open the Coronary artery [ATLANTIC, NCT01347580]).

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1876-7605

Publisher:

Elsevier

Language:

English

Submitter:

Daria Vogelsang

Date Deposited:

29 May 2017 08:34

Last Modified:

29 May 2017 08:34

Publisher DOI:

10.1016/j.jcin.2015.12.024

PubMed ID:

26952907

Additional Information:

ATLANTIC Investigators: Marco Valgimigli

Uncontrolled Keywords:

myocardial infarction; platelets; reperfusion; stents; thrombosis

BORIS DOI:

10.7892/boris.92879

URI:

https://boris.unibe.ch/id/eprint/92879

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