Prehospital ticagrelor in ST-segment elevation myocardial infarction
Gilles Montalescot, Arnoud W van 't Hof, Frédéric Lapostolle, Johanne Silvain, Jens Flensted Lassen, Leonardo Bolognese, Warren J Cantor, Angel Cequier, Mohamed Chettibi, Shaun G Goodman, Christopher J Hammett, Kurt Huber, Magnus Janzon, Béla Merkely, Robert F Storey, Uwe Zeymer, Olivier Stibbe, Patrick Ecollan, Wim M J M Heutz, Eva Swahn, Jean-Philippe Collet, Frank F Willems, Caroline Baradat, Muriel Licour, Anne Tsatsaris, Eric Vicaut, Christian W Hamm, ATLANTIC Investigators, Rachid Bougherbal, Mohamed Tahar Bouafia, Mohamed Chettibi, Djamaleddine Nibouche, Abdelkader Moklati, Ahmed Benalia, Omar Kaid, Messaad Krim, Christopher Hammett, Paul Garraby, Rohan Jayasinghe, Stephen Rashford, Kurt Huber, Thomas Neunteufl, Helmut Brussee, Hannes Alber, Franz Weidinger, Michael Brunner, Johann Sipoetz, Gerhard Prause, Michael Baubin, Dieter Sebald, Warren Cantor, Ram Vijayaraghavan, Iqbal Bata, Andrea Lavoie, Jens Flensted Lassen, Jan Ravkilde, Lisette Okkels Jensen, Alf Møl Christensen, Marianne Toftegaard, Dennis Köhler, Gilles Montalescot, Gregory Ducrocq, Nicolas Danchin, Patrick Henry, Bernard Livarek, Romain Berthier, Thomas Hovasse, Philippe Garot, Laurent Payot, Hakim Benamer, Jean Baptiste Esteve, Simon Elhadad, Emmanuel Teiger, Jean Louis Bonnet, Franck Paganelli, Yves Cottin, François Schiele, Christophe Thuaire, Guillaume Cayla, Pierre Coste, Patrick Ohlmann, Eric Bonnefoy Cudraz, Pierre Lantelme, Thibault Perret, Christophe Tron, Axel De Labriolle, Edouardo Aptecar, Olivier Beliard, Olivier Varenne, Rami El Mahmoud, Emmanuelle Filippi-Codaccioni, Denis Angoulvant, Patrick Peycher, Olivier Poitrineau, Xavier Tabone, Patrick Ecollan, Claire Broche, Yves Lambert, Nicolas Briole, Arielle Beruben, Nicolas Porcher, Jean-Pierre Auffray, Marc Freysz, Franck Depardieu, David Poubel, Jean-Emmanuel De La Cousaye, Jean-Claude Bartier, Benoît Jardel, Bertrand Boulanger, Hervé Labourel, Louis-Christophe Soulat, Frédéric Lapostolle, Véronique Julie, Michel Thicoipe, Olivier Capel, Olivier Stibbe, Pierre Carli, Karim Tazarourte, Fabrice Alcouffe, David Aboucaya, Gaële Aubert, Gérald Kierzek, Séverine Cahun-Giraud, Uwe Zeymer, Christian Hamm, Thomas Dengler, Roland Prondzinsky, Paul Marc Biever, Andreas Schäfer, Melchior Seyfarth, Bernd Lemke, Gerald Werner, Holger Nef, Holger Steiger, Matthias Leschke, Thomas Münzel, Marco Campo Dell Orto, Christian Loges, Monika Schinke, Frank Koberne, Hans Peter Reiffen, Klaus Tiroch, Dirk Wierich, Michael Kneussel, Simon Little, Hartmut Sauer, Rita Laufenberg-Feldmann, Béla Merkely, Imre Ungi, Iván Horváth, István Édes, István Mártai, Leonardo Bolognese, Sergio Berti, Francesco Chiarella, Paolo Calabria, Massimo Fineschi, Marcello Galvani, Marco Valgimigli, Luciano Moretti, Maurizio Tespili, Massimo Mandó, Francesco Bermano, Robusto Biagioni, Andrea Fabbri, Adelina Ricciardelli, Maria Romana Petroni, Umberto Roberto Vatteroni, Francesco Palumbo, Frank F Willems, Amar Al mafragi, Ton A A C M Heestermans, Martijn J Van Eck, Wim M J M Heutz, H H Meppelder, Anika Roukema-de Jong, Harm Van de Pas, Ángel Cequier Fillat, Manel Sabaté Tenas, Josepa Mauri Ferrer, Antoni Serra Peñaranda, Joan Ángel Ferrer, Bruno García Del Blanco, Faustino Miranda Guardiola, Juan Miguel Ruiz Nodar, Andrés Íñiguez Romo, Nicolás Vázquez González, Ramiro Trillo Nouche, Luis Díaz De La Llera, José María Hernández García, Fernando Rivero-Crespo, Felipe Hernández Hernández, José Luis Zamorano Gómez, Xavier Jiménez Fárega, Gilberto Alonso Fernández, José Luis Toboso, Mercedes Carrasco, Victoria Barreiro, José Antonio Iglesias Vázquez, María del Mar Ruiz Montero, Fernando Rosell Ortiz, Guillermo Garcia Escudero, Vicente Sánchez-Brunete Ingelmo, Antonio Lara García, Magnus Janzon, Jonas Oldgren, Fredrik Calais, Robert Kastberg, Per-Adolf Bergsten, Hans Blomberg, Kristian Thörn, Gunnar Skoog, Robert F Storey, Azfar Zaman, Robert Gerber, Alisdair Ryding, Mark Spence, Neil Swanson, Martin Been, Konrad Grosser, Peter Schofield, David Mackin, Paul Fell, Tom Quinn, Teresa Foster, David McManus, Andy Carson, Robert Wilcox, David Gray, William Smith, Timothy Taylor, Gilles Montalescot, Arnoud W van't Hof, Christian W Hamm, Frédéric Lapostolle, Jens Flensted Lassen, Caroline Baradat, Muriel Licour, Anne Tsatsaris, Gilles Montalescot, Arnoud W van't Hof, Christian W Hamm, Frédéric Lapostolle, Jens Flensted Lassen, Warren J Cantor, Jurriën M ten Berg, Leonardo Bolognese, Ángel Cequier, Mohamed Chettibi, Shaun G Goodman, Christopher J Hammett, Kurt Huber, Magnus Janzon, Béla Merkely, Robert F Storey, Uwe Zeymer, Caroline Baradat, Muriel Licour, Néjoua Salhi, Anne Tsatsaris, Stuart Pocock, Philippe Gabriel Steg, Angeles Alonso Garcia, Gilles Montalescot, Arnoud W van 't Hof, Frédéric Lapostolle, Johanne Silvain, Jens Flensted Lassen, Leonardo Bolognese, Warren J Cantor, Angel Cequier, Mohamed Chettibi, Shaun G Goodman, Christopher J Hammett, Kurt Huber, Magnus Janzon, Béla Merkely, Robert F Storey, Uwe Zeymer, Olivier Stibbe, Patrick Ecollan, Wim M J M Heutz, Eva Swahn, Jean-Philippe Collet, Frank F Willems, Caroline Baradat, Muriel Licour, Anne Tsatsaris, Eric Vicaut, Christian W Hamm, ATLANTIC Investigators, Rachid Bougherbal, Mohamed Tahar Bouafia, Mohamed Chettibi, Djamaleddine Nibouche, Abdelkader Moklati, Ahmed Benalia, Omar Kaid, Messaad Krim, Christopher Hammett, Paul Garraby, Rohan Jayasinghe, Stephen Rashford, Kurt Huber, Thomas Neunteufl, Helmut Brussee, Hannes Alber, Franz Weidinger, Michael Brunner, Johann Sipoetz, Gerhard Prause, Michael Baubin, Dieter Sebald, Warren Cantor, Ram Vijayaraghavan, Iqbal Bata, Andrea Lavoie, Jens Flensted Lassen, Jan Ravkilde, Lisette Okkels Jensen, Alf Møl Christensen, Marianne Toftegaard, Dennis Köhler, Gilles Montalescot, Gregory Ducrocq, Nicolas Danchin, Patrick Henry, Bernard Livarek, Romain Berthier, Thomas Hovasse, Philippe Garot, Laurent Payot, Hakim Benamer, Jean Baptiste Esteve, Simon Elhadad, Emmanuel Teiger, Jean Louis Bonnet, Franck Paganelli, Yves Cottin, François Schiele, Christophe Thuaire, Guillaume Cayla, Pierre Coste, Patrick Ohlmann, Eric Bonnefoy Cudraz, Pierre Lantelme, Thibault Perret, Christophe Tron, Axel De Labriolle, Edouardo Aptecar, Olivier Beliard, Olivier Varenne, Rami El Mahmoud, Emmanuelle Filippi-Codaccioni, Denis Angoulvant, Patrick Peycher, Olivier Poitrineau, Xavier Tabone, Patrick Ecollan, Claire Broche, Yves Lambert, Nicolas Briole, Arielle Beruben, Nicolas Porcher, Jean-Pierre Auffray, Marc Freysz, Franck Depardieu, David Poubel, Jean-Emmanuel De La Cousaye, Jean-Claude Bartier, Benoît Jardel, Bertrand Boulanger, Hervé Labourel, Louis-Christophe Soulat, Frédéric Lapostolle, Véronique Julie, Michel Thicoipe, Olivier Capel, Olivier Stibbe, Pierre Carli, Karim Tazarourte, Fabrice Alcouffe, David Aboucaya, Gaële Aubert, Gérald Kierzek, Séverine Cahun-Giraud, Uwe Zeymer, Christian Hamm, Thomas Dengler, Roland Prondzinsky, Paul Marc Biever, Andreas Schäfer, Melchior Seyfarth, Bernd Lemke, Gerald Werner, Holger Nef, Holger Steiger, Matthias Leschke, Thomas Münzel, Marco Campo Dell Orto, Christian Loges, Monika Schinke, Frank Koberne, Hans Peter Reiffen, Klaus Tiroch, Dirk Wierich, Michael Kneussel, Simon Little, Hartmut Sauer, Rita Laufenberg-Feldmann, Béla Merkely, Imre Ungi, Iván Horváth, István Édes, István Mártai, Leonardo Bolognese, Sergio Berti, Francesco Chiarella, Paolo Calabria, Massimo Fineschi, Marcello Galvani, Marco Valgimigli, Luciano Moretti, Maurizio Tespili, Massimo Mandó, Francesco Bermano, Robusto Biagioni, Andrea Fabbri, Adelina Ricciardelli, Maria Romana Petroni, Umberto Roberto Vatteroni, Francesco Palumbo, Frank F Willems, Amar Al mafragi, Ton A A C M Heestermans, Martijn J Van Eck, Wim M J M Heutz, H H Meppelder, Anika Roukema-de Jong, Harm Van de Pas, Ángel Cequier Fillat, Manel Sabaté Tenas, Josepa Mauri Ferrer, Antoni Serra Peñaranda, Joan Ángel Ferrer, Bruno García Del Blanco, Faustino Miranda Guardiola, Juan Miguel Ruiz Nodar, Andrés Íñiguez Romo, Nicolás Vázquez González, Ramiro Trillo Nouche, Luis Díaz De La Llera, José María Hernández García, Fernando Rivero-Crespo, Felipe Hernández Hernández, José Luis Zamorano Gómez, Xavier Jiménez Fárega, Gilberto Alonso Fernández, José Luis Toboso, Mercedes Carrasco, Victoria Barreiro, José Antonio Iglesias Vázquez, María del Mar Ruiz Montero, Fernando Rosell Ortiz, Guillermo Garcia Escudero, Vicente Sánchez-Brunete Ingelmo, Antonio Lara García, Magnus Janzon, Jonas Oldgren, Fredrik Calais, Robert Kastberg, Per-Adolf Bergsten, Hans Blomberg, Kristian Thörn, Gunnar Skoog, Robert F Storey, Azfar Zaman, Robert Gerber, Alisdair Ryding, Mark Spence, Neil Swanson, Martin Been, Konrad Grosser, Peter Schofield, David Mackin, Paul Fell, Tom Quinn, Teresa Foster, David McManus, Andy Carson, Robert Wilcox, David Gray, William Smith, Timothy Taylor, Gilles Montalescot, Arnoud W van't Hof, Christian W Hamm, Frédéric Lapostolle, Jens Flensted Lassen, Caroline Baradat, Muriel Licour, Anne Tsatsaris, Gilles Montalescot, Arnoud W van't Hof, Christian W Hamm, Frédéric Lapostolle, Jens Flensted Lassen, Warren J Cantor, Jurriën M ten Berg, Leonardo Bolognese, Ángel Cequier, Mohamed Chettibi, Shaun G Goodman, Christopher J Hammett, Kurt Huber, Magnus Janzon, Béla Merkely, Robert F Storey, Uwe Zeymer, Caroline Baradat, Muriel Licour, Néjoua Salhi, Anne Tsatsaris, Stuart Pocock, Philippe Gabriel Steg, Angeles Alonso Garcia
Abstract
Background: The direct-acting platelet P2Y12 receptor antagonist ticagrelor can reduce the incidence of major adverse cardiovascular events when administered at hospital admission to patients with ST-segment elevation myocardial infarction (STEMI). Whether prehospital administration of ticagrelor can improve coronary reperfusion and the clinical outcome is unknown.
Methods: We conducted an international, multicenter, randomized, double-blind study involving 1862 patients with ongoing STEMI of less than 6 hours' duration, comparing prehospital (in the ambulance) versus in-hospital (in the catheterization laboratory) treatment with ticagrelor. The coprimary end points were the proportion of patients who did not have a 70% or greater resolution of ST-segment elevation before percutaneous coronary intervention (PCI) and the proportion of patients who did not have Thrombolysis in Myocardial Infarction flow grade 3 in the infarct-related artery at initial angiography. Secondary end points included the rates of major adverse cardiovascular events and definite stent thrombosis at 30 days.
Results: The median time from randomization to angiography was 48 minutes, and the median time difference between the two treatment strategies was 31 minutes. The two coprimary end points did not differ significantly between the prehospital and in-hospital groups. The absence of ST-segment elevation resolution of 70% or greater after PCI (a secondary end point) was reported for 42.5% and 47.5% of the patients, respectively. The rates of major adverse cardiovascular events did not differ significantly between the two study groups. The rates of definite stent thrombosis were lower in the prehospital group than in the in-hospital group (0% vs. 0.8% in the first 24 hours; 0.2% vs. 1.2% at 30 days). Rates of major bleeding events were low and virtually identical in the two groups, regardless of the bleeding definition used.
Conclusions: Prehospital administration of ticagrelor in patients with acute STEMI appeared to be safe but did not improve pre-PCI coronary reperfusion. (Funded by AstraZeneca; ATLANTIC ClinicalTrials.gov number, NCT01347580.).
Source: PubMed