title: Prehospital ticagrelor in ST-segment elevation myocardial infarction.
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.).
authors.affiliation: The authors' affiliations are listed in the Appendix.
authors.forename: Gilles
authors.initials: G
authors.lastname: Montalescot
authors.forename: Arnoud W
authors.initials: AW
authors.lastname: van 't Hof
authors.forename: Frédéric
authors.initials: F
authors.lastname: Lapostolle
authors.forename: Johanne
authors.initials: J
authors.lastname: Silvain
authors.forename: Jens Flensted
authors.initials: JF
authors.lastname: Lassen
authors.forename: Leonardo
authors.initials: L
authors.lastname: Bolognese
authors.forename: Warren J
authors.initials: WJ
authors.lastname: Cantor
authors.forename: Angel
authors.initials: A
authors.lastname: Cequier
authors.forename: Mohamed
authors.initials: M
authors.lastname: Chettibi
authors.forename: Shaun G
authors.initials: SG
authors.lastname: Goodman
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Hammett
authors.forename: Kurt
authors.initials: K
authors.lastname: Huber
authors.forename: Magnus
authors.initials: M
authors.lastname: Janzon
authors.forename: Béla
authors.initials: B
authors.lastname: Merkely
authors.forename: Robert F
authors.initials: RF
authors.lastname: Storey
authors.forename: Uwe
authors.initials: U
authors.lastname: Zeymer
authors.forename: Olivier
authors.initials: O
authors.lastname: Stibbe
authors.forename: Patrick
authors.initials: P
authors.lastname: Ecollan
authors.forename: Wim M J M
authors.initials: WM
authors.lastname: Heutz
authors.forename: Eva
authors.initials: E
authors.lastname: Swahn
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Collet
authors.forename: Frank F
authors.initials: FF
authors.lastname: Willems
authors.forename: Caroline
authors.initials: C
authors.lastname: Baradat
authors.forename: Muriel
authors.initials: M
authors.lastname: Licour
authors.forename: Anne
authors.initials: A
authors.lastname: Tsatsaris
authors.forename: Eric
authors.initials: E
authors.lastname: Vicaut
authors.forename: Christian W
authors.initials: CW
authors.lastname: Hamm
mesh_terms: D000241:Adenosine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D000077144:Clopidogrel; D017023:Coronary Angiography; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004562:Electrocardiography / Q000187:drug effects; D004632:Emergency Medical Services; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D015425:Myocardial Reperfusion; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D000077486:Ticagrelor; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D061665:Time-to-Treatment
chemical_list: D000925:Anticoagulants; D058921:Purinergic P2Y Receptor Antagonists; D000077144:Clopidogrel; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine