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-H-24 Analysis
Por:
Montalescot, G, van't Hof, AW, Bolognese, L, Cantor, WJ, Cequier, A, Chettibi, M, Collet, JP, Goodman, SG, Hammett, CJ, Huber, K, Janzon, M, Lapostolle, F, Lassen, JF, Licour, M, Merkely, B, Salhi, N, Silvain, J, Storey, RF, ten Berg, JM, Tsatsaris, A, Zeymer, U, Vicaut, E, Hamm, CW, Peñaranda, A.S., Carson, Andy
Publicada:
11 abr 2016
Resumen:
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]) (C) 2016 by the American College of Cardiology Foundation.
Filiaciones:
Montalescot, G:
Univ Paris 06, ACTION Study Grp, Ctr Hosp Univ Pitie Salpetriere, Inst Cardiol AP HP,INSERM UMRS 1166, Paris, France
van't Hof, AW:
Isala Clin, Dept Cardiol, Zwolle, Netherlands
Bolognese, L:
Azienda Osped Arezzo, Cardiovasc & Neurol Dept, Arezzo, Italy
Cantor, WJ:
Univ Toronto, Southlake Reg Hlth Ctr, Toronto, ON M5S 1A1, Canada
Cequier, A:
Univ Barcelona, LHosp Llobregat, Hosp Univ Bellvitge, Heart Dis Inst, Barcelona, Spain
Chettibi, M:
Ctr Hosp Univ Frantz Fanon, Blida, Algeria
Collet, JP:
Univ Paris 06, ACTION Study Grp, Ctr Hosp Univ Pitie Salpetriere, Inst Cardiol AP HP,INSERM UMRS 1166, Paris, France
Goodman, SG:
Univ Toronto, St Michaels Hosp, Div Cardiol, Canadian Heart Res Ctr, Toronto, ON, Canada
Hammett, CJ:
Royal Brisbane & Womens Hosp, Dept Cardiol, Brisbane, Qld, Australia
Huber, K:
Wilhelminenhosp, Dept Med Cardiol & Intens Care Med 3, Vienna, Austria
Janzon, M:
Linkoping Univ, Dept Cardiol, Linkoping, Sweden
Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden
Lapostolle, F:
SAMU 93 Hop Avicenne, Bobigny, France
Lassen, JF:
Aarhus Univ Hosp, Dept Cardiol B, DK-8000 Aarhus N, Denmark
Licour, M:
AstraZeneca, Rueil Malmaison, France
Merkely, B:
Semmelweis Univ, Heart & Vasc Ctr, H-1085 Budapest, Hungary
Salhi, N:
AstraZeneca, Luton, Beds, England
Silvain, J:
Univ Paris 06, ACTION Study Grp, Ctr Hosp Univ Pitie Salpetriere, Inst Cardiol AP HP,INSERM UMRS 1166, Paris, France
Storey, RF:
Univ Sheffield, Dept Cardiovasc Sci, Sheffield, S Yorkshire, England
ten Berg, JM:
St Antonius Hosp, Dept Cardiol, Nieuwegein, Netherlands
Tsatsaris, A:
AstraZeneca, Rueil Malmaison, France
Zeymer, U:
Klinikum Ludwigshafen, Ludwigshafen, Germany
Inst Herzinfarktforsch Ludwigshafen, Ludwigshafen, Germany
Vicaut, E:
Univ Paris 07, Unite Rech Clin, Hop Lariboisiere, ACTION Study Grp, Paris, France
Hamm, CW:
Kerckhoff Heart Ctr, Dept Cardiol, Bad Nauheim, Germany
Peñaranda, A.S.:
Hospital de la Santa Creu i Sant Pau
Carson, Andy :
West Midlands Ambulance Service University NHS Foundation Trust, Brierley Hill, United Kingdom
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