TY - JOUR
T1 - Duration of ischemia and treatment effects of pre- versus in-hospital ticagrelor in patients with ST-segment elevation myocardial infarction
T2 - Insights from the ATLANTIC study
AU - Bagai, Akshay
AU - Goodman, Shaun G
AU - Cantor, Warren J
AU - Vicaut, Eric
AU - Bolognese, Leonardo
AU - Cequier, Angel
AU - Chettibi, Mohamed
AU - Hammett, Christopher J
AU - Huber, Kurt
AU - Janzon, Magnus
AU - Lapostolle, Frédéric
AU - Lassen, Jens Flensted
AU - Merkely, Béla
AU - Storey, Robert F
AU - Ten Berg, Jurriën M
AU - Zeymer, Uwe
AU - Diallo, Abdourahmane
AU - Hamm, Christian W
AU - Tsatsaris, Anne
AU - El Khoury, Jad
AU - Van't Hof, Arnoud W
AU - Montalescot, Gilles
N1 - Copyright © 2017 Elsevier Inc. All rights reserved.
PY - 2018/2
Y1 - 2018/2
N2 - BACKGROUND: 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 30 days between randomized treatment groups (pre- versus in-hospital ticagrelor) stratified by symptom onset to first medical contact (FMC) duration [≤1 hour (n = 773), >1 to ≤3 hours (n = 772), and >3 hours (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 hours had the greatest improvement in post-PCI ST-segment elevation resolution with pre- versus in-hospital ticagrelor (absolute risk difference: ≤1 hour, 2.9% vs. >1 to ≤3 hours, 3.6% vs. >3 hours, 12.2%; adjusted p for interaction = 0.13), while patients with shorter duration of ischemia had greater improvement in stent thrombosis at 30 days with pre- versus in-hospital ticagrelor (absolute risk difference: ≤1 hour, 1.3% vs. >1 hour to ≤3 hours, 0.7% vs. >3 hours, 0.4%; adjusted p for interaction = 0.55). Symptom onset to active ticagrelor administration was independently associated with stent thrombosis at 30 days (adjusted OR 1.89 per 100 minute 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 3 hours 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.
AB - BACKGROUND: 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 30 days between randomized treatment groups (pre- versus in-hospital ticagrelor) stratified by symptom onset to first medical contact (FMC) duration [≤1 hour (n = 773), >1 to ≤3 hours (n = 772), and >3 hours (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 hours had the greatest improvement in post-PCI ST-segment elevation resolution with pre- versus in-hospital ticagrelor (absolute risk difference: ≤1 hour, 2.9% vs. >1 to ≤3 hours, 3.6% vs. >3 hours, 12.2%; adjusted p for interaction = 0.13), while patients with shorter duration of ischemia had greater improvement in stent thrombosis at 30 days with pre- versus in-hospital ticagrelor (absolute risk difference: ≤1 hour, 1.3% vs. >1 hour to ≤3 hours, 0.7% vs. >3 hours, 0.4%; adjusted p for interaction = 0.55). Symptom onset to active ticagrelor administration was independently associated with stent thrombosis at 30 days (adjusted OR 1.89 per 100 minute 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 3 hours 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.
KW - Aged
KW - Coronary Angiography/methods
KW - Disease Progression
KW - Double-Blind Method
KW - Electrocardiography/methods
KW - Emergency Medical Services/methods
KW - Female
KW - Humans
KW - Internationality
KW - Male
KW - Middle Aged
KW - Myocardial Ischemia/diagnostic imaging
KW - Percutaneous Coronary Intervention/methods
KW - Prognosis
KW - Risk Assessment
KW - ST Elevation Myocardial Infarction/diagnostic imaging
KW - Stents
KW - Survival Analysis
KW - Ticagrelor/administration & dosage
KW - Time-to-Treatment
KW - Treatment Outcome
KW - MORTALITY
KW - REPERFUSION
KW - PREDICTORS
KW - PRIMARY ANGIOPLASTY
KW - STENT THROMBOSIS
KW - SIZE
KW - TIME
KW - PERCUTANEOUS CORONARY INTERVENTION
KW - PREHOSPITAL TICAGRELOR
KW - DOUBLE-BLIND
U2 - 10.1016/j.ahj.2017.10.021
DO - 10.1016/j.ahj.2017.10.021
M3 - Article
C2 - 29421015
SN - 0002-8703
VL - 196
SP - 56
EP - 64
JO - American Heart Journal
JF - American Heart Journal
ER -