TY - JOUR
T1 - Pre-hospital administration of ticagrelor in diabetic patients with ST-elevation myocardial infarction undergoing primary angioplasty
T2 - A sub-analysis of the ATLANTIC trial
AU - Fabris, Enrico
AU - van't Hof, Arnoud
AU - Hamm, Christian W.
AU - Lapostolle, Frederic
AU - Lassen, Jens Flensted
AU - Goodman, Shaun G.
AU - ten Berg, Jurrien M.
AU - Bolognese, Leonardo
AU - Cequier, Angel
AU - Chettibi, Mohamed
AU - Hammett, Christopher J.
AU - Huber, Kurt
AU - Janzon, Magnus
AU - Merkely, Bela
AU - Storey, Robert F.
AU - Zeymer, Uwe
AU - Cantor, Warren J.
AU - Kerneis, Mathieu
AU - Diallo, Abdourahmane
AU - Vicaut, Eric
AU - Montalescot, Gilles
AU - ATLANTIC Investigators
N1 - Funding Information:
This study was supported by Astrazeneca.
Publisher Copyright:
© 2018 Wiley Periodicals, Inc.
PY - 2019/6/1
Y1 - 2019/6/1
N2 - Objective We investigated, in the contemporary era of ST-elevation myocardial infarction (STEMI) treatment, the influence of diabetes mellitus (DM) on cardiovascular outcomes, and whether pre-hospital administration of ticagrelor may affect these outcomes in a subgroup of STEMI patients with DM. Background DM patients have high platelet reactivity and a prothrombotic condition which highlight the importance of an effective antithrombotic regimen in this high-risk population. Methods In toal 1,630 STEMI patients enrolled in the ATLANTIC trial who underwent primary percutaneous coronary intervention (PCI) were included. Multivariate analysis was used to explore the association of DM with outcomes and potential treatment-by-diabetes interaction was tested. Results A total of 214/1,630 (13.1%) patients had DM. DM was an independent predictor of poor myocardial reperfusion as reflected by less frequent ST-segment elevation resolution (>= 70%) after PCI (OR 0.59, 95% CI 0.43-0.82, P <0.01) and was an independent predictor of the composite 30-day outcomes of death/new myocardial infarction (MI)/urgent revascularization/definite stent thrombosis (ST) (OR 2.80, 95% CI 1.62-4.85, P <0.01), new MI or definite acute ST (OR 2.46, 95% CI 1.08-5.61, P = 0.03), and definite ST (OR 10.00, 95% CI 3.54-28.22, P <0.01). No significant interaction between pre-hospital ticagrelor vs in-hospital ticagrelor administration and DM was present for the clinical, electrocardiographic and angiographic outcomes as well as for thrombolysis in myocardial infarction major bleeding. Conclusions DM remains independently associated with poor myocardial reperfusion and worse 30-day clinical outcomes. No significant interaction was found between pre-hospital vs in-hospital ticagrelor administration and DM status. Further approaches for the treatment of DM patients are needed. CLINICAL TRIAL REGISTRATION identifier: NCT01347580.
AB - Objective We investigated, in the contemporary era of ST-elevation myocardial infarction (STEMI) treatment, the influence of diabetes mellitus (DM) on cardiovascular outcomes, and whether pre-hospital administration of ticagrelor may affect these outcomes in a subgroup of STEMI patients with DM. Background DM patients have high platelet reactivity and a prothrombotic condition which highlight the importance of an effective antithrombotic regimen in this high-risk population. Methods In toal 1,630 STEMI patients enrolled in the ATLANTIC trial who underwent primary percutaneous coronary intervention (PCI) were included. Multivariate analysis was used to explore the association of DM with outcomes and potential treatment-by-diabetes interaction was tested. Results A total of 214/1,630 (13.1%) patients had DM. DM was an independent predictor of poor myocardial reperfusion as reflected by less frequent ST-segment elevation resolution (>= 70%) after PCI (OR 0.59, 95% CI 0.43-0.82, P <0.01) and was an independent predictor of the composite 30-day outcomes of death/new myocardial infarction (MI)/urgent revascularization/definite stent thrombosis (ST) (OR 2.80, 95% CI 1.62-4.85, P <0.01), new MI or definite acute ST (OR 2.46, 95% CI 1.08-5.61, P = 0.03), and definite ST (OR 10.00, 95% CI 3.54-28.22, P <0.01). No significant interaction between pre-hospital ticagrelor vs in-hospital ticagrelor administration and DM was present for the clinical, electrocardiographic and angiographic outcomes as well as for thrombolysis in myocardial infarction major bleeding. Conclusions DM remains independently associated with poor myocardial reperfusion and worse 30-day clinical outcomes. No significant interaction was found between pre-hospital vs in-hospital ticagrelor administration and DM status. Further approaches for the treatment of DM patients are needed. CLINICAL TRIAL REGISTRATION identifier: NCT01347580.
KW - antithrombotic drug
KW - diabetes mellitus
KW - STEMI
KW - ticagrelor
KW - ACUTE CORONARY SYNDROMES
KW - PLATELET INHIBITION
KW - CLOPIDOGREL
KW - OUTCOMES
KW - REACTIVITY
KW - MELLITUS
U2 - 10.1002/ccd.27921
DO - 10.1002/ccd.27921
M3 - Article
C2 - 30302940
SN - 1522-1946
VL - 93
SP - E369-E377
JO - Catheterization and Cardiovascular interventions
JF - Catheterization and Cardiovascular interventions
IS - 7
ER -