5 years ago

Duration of Ischemia and Treatment Effects of Pre- Versus In-Hospital Ticagrelor in Patients with ST-Segment Elevation Myocardial Infarction: Insights from the ATLANTIC study

Among patients with STEMI in the ATLANTIC study, pre-hospital administration of ticagrelor improved post-PCI ST-segment resolution and 30-day stent thrombosis. We investigated whether this clinical benefit with pre-hospital ticagrelor differs by ischemic duration. Methods In a post hoc analysis we compared absence of ST-segment resolution post-PCI and stent thrombosis at 30days between randomized treatment groups (pre- versus in-hospital ticagrelor) stratified by symptom onset to first medical contact (FMC) duration [≤1 hr. (n=773), >1 to ≤3 hrs (n=772), and >3 hrs (n=311)], examining the interaction between randomized treatment strategy and duration of symptom onset to FMC for each outcome. Results Patients presenting later after symptom onset were older, more likely to be female, and have higher baseline risk. Patients with symptom onset to FMC >3 hrs had the greatest improvement in post-PCI ST-segment elevation resolution with pre- versus in-hospital ticagrelor (absolute risk difference: ≤1 hr., 2.9% vs. >1 to ≤3 hrs, 3.6% vs. >3 hrs, 12.2%; adjusted p for interaction=0.13), while patients with shorter duration of ischemia had greater improvement in stent thrombosis at 30days with pre- versus in-hospital ticagrelor (absolute risk difference: ≤1 hr., 1.3% vs. >1 hr. to ≤3 hrs, 0.7% vs. >3 hrs, 0.4%; adjusted p for interaction=0.55). Symptom onset to active ticagrelor administration was independently associated with stent thrombosis at 30days (adjusted OR 1.89 per 100minute delay, 95%CI 1.20–2.97, P <.01), but not post-PCI ST-segment resolution (P =.41). Conclusions The effect of pre-hospital ticagrelor to reduce stent thrombosis was most evident when given early within 3hours after symptom onset, with delay in ticagrelor administration after symptom onset associated with higher rate of stent thrombosis. These findings re-emphasize the need for early ticagrelor administration in primary PCI treated STEMI patients.

Publisher URL: www.sciencedirect.com/science

DOI: S0002870317303514

You might also like
Discover & Discuss Important Research

Keeping up-to-date with research can feel impossible, with papers being published faster than you'll ever be able to read them. That's where Researcher comes in: we're simplifying discovery and making important discussions happen. With over 19,000 sources, including peer-reviewed journals, preprints, blogs, universities, podcasts and Live events across 10 research areas, you'll never miss what's important to you. It's like social media, but better. Oh, and we should mention - it's free.

  • Download from Google Play
  • Download from App Store
  • Download from AppInChina

Researcher displays publicly available abstracts and doesn’t host any full article content. If the content is open access, we will direct clicks from the abstracts to the publisher website and display the PDF copy on our platform. Clicks to view the full text will be directed to the publisher website, where only users with subscriptions or access through their institution are able to view the full article.