TY - JOUR
T1 - Thrombus aspiration and prehospital ticagrelor administration in ST-elevation myocardial infarction: Findings from the ATLANTIC trial
AU - Kilic, Sinem
AU - Fabris, Enrico
AU - van't Hof, Arnoud W. J.
AU - Hamm, Christian W.
AU - Lapostolle, Frederic
AU - Lassen, Jens Flensted
AU - Tsatsaris, Anne
AU - Diallo, Abdourahmane
AU - Vicaut, Eric
AU - Montalescot, Gilles
AU - ATLANTIC Investigators
PY - 2018/2/1
Y1 - 2018/2/1
N2 - Background The potential interactions between prehospital (pre-H) ticagrelor administration and thrombus aspiration (TA) in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) have never been studied. Therefore, we evaluated the potential benefit of TA and pre-H ticagrelor treatment in patients enrolled in the ATLANTIC trial (NCT01347580). Methods This analysis included 1,630 patients who underwent primary PCI. Multivariate analysis was used to explore the potential association of TA and pre-H treatment to clinical outcomes. Potential interactions between TA and pre-H ticagrelor were also explored. Results A total of 941 (57.7%) patients underwent TA. In adjusted multivariate logistic model, pre-H ticagrelor treatment was significantly associated with less frequent new MI or definite stent *thrombosis (ST) (odds ratio [OR] 0.43, 95% CI 0.20-0.92, P = .031), or definite ST (OR 0.26, 95% CI 0.07-0.91, P = .036) at 30 days. Patients treated with TA had higher frequency of Thrombolysis in Myocardial Infarction (TIMI) flow 0-1 compared with no-TA group (80.7% vs 51.9%, P < .0001). TA when also adjusted for TIMI flow 0-1 showed significant association only for higher bailout use of glycoprotein IIb/IIIa inhibitors (OR 1.72, 95% CI 1.18-2.50, P = .004) and more frequent 30-day TIMI major bleeding (OR 2.92, 95% CI 1.107.76, P = .032). No significant interactions between TA and pre-H ticagrelor were present for the explored end points. Conclusions TA when left to physicians' discretion was used in high-risk patients, was associated with bailout use of glycoprotein IIb/IIIa inhibitors and TIMI major bleeding, and had no impact on 30-day clinical outcomes. Conversely, pre-H ticagrelor treatment predicted lower 30-day rates of ST or new MI without interaction with TA.
AB - Background The potential interactions between prehospital (pre-H) ticagrelor administration and thrombus aspiration (TA) in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) have never been studied. Therefore, we evaluated the potential benefit of TA and pre-H ticagrelor treatment in patients enrolled in the ATLANTIC trial (NCT01347580). Methods This analysis included 1,630 patients who underwent primary PCI. Multivariate analysis was used to explore the potential association of TA and pre-H treatment to clinical outcomes. Potential interactions between TA and pre-H ticagrelor were also explored. Results A total of 941 (57.7%) patients underwent TA. In adjusted multivariate logistic model, pre-H ticagrelor treatment was significantly associated with less frequent new MI or definite stent *thrombosis (ST) (odds ratio [OR] 0.43, 95% CI 0.20-0.92, P = .031), or definite ST (OR 0.26, 95% CI 0.07-0.91, P = .036) at 30 days. Patients treated with TA had higher frequency of Thrombolysis in Myocardial Infarction (TIMI) flow 0-1 compared with no-TA group (80.7% vs 51.9%, P < .0001). TA when also adjusted for TIMI flow 0-1 showed significant association only for higher bailout use of glycoprotein IIb/IIIa inhibitors (OR 1.72, 95% CI 1.18-2.50, P = .004) and more frequent 30-day TIMI major bleeding (OR 2.92, 95% CI 1.107.76, P = .032). No significant interactions between TA and pre-H ticagrelor were present for the explored end points. Conclusions TA when left to physicians' discretion was used in high-risk patients, was associated with bailout use of glycoprotein IIb/IIIa inhibitors and TIMI major bleeding, and had no impact on 30-day clinical outcomes. Conversely, pre-H ticagrelor treatment predicted lower 30-day rates of ST or new MI without interaction with TA.
KW - PERCUTANEOUS CORONARY INTERVENTION
KW - 1-YEAR FOLLOW-UP
KW - SEGMENT-ELEVATION
KW - RANDOMIZED-TRIAL
KW - REMEDIA TRIAL
KW - THROMBECTOMY
KW - REPERFUSION
KW - GUIDELINES
KW - MANAGEMENT
KW - REDUCTION
U2 - 10.1016/j.ahj.2017.09.018
DO - 10.1016/j.ahj.2017.09.018
M3 - Article
C2 - 29421001
SN - 0002-8703
VL - 196
SP - 1
EP - 8
JO - American Heart Journal
JF - American Heart Journal
ER -