title: Prehospital administration of P2Y12 inhibitors and early coronary reperfusion in primary PCI: an observational comparative study.
abstract: The newer oral P2Y12 inhibitors prasugrel and ticagrelor have been reported to be more potent and faster-acting antiplatelet agents than clopidogrel. This study aimed to investigate whether prehospital loading with prasugrel or ticagrelor improves early coronary reperfusion as compared to prehospital loading with clopidogrel in a real-world ST-elevation myocardial infarction (STEMI) setting. Over a 70-month period, 3497 patients with on-going STEMI of less than 6 hours and without cardiac arrest or cardiogenic shock underwent primary percutaneous coronary intervention (PPCI) at our centre. The primary endpoint of this study was the proportion of patients who did not meet the criteria for TIMI (Thrombolysis In Myocardial Infarction) flow grade 3 in the infarct-related artery at initial angiography before PPCI. Prehospital loading with prasugrel (n = 883) or ticagrelor (n = 491) did not significantly improve coronary reperfusion as compared to prehospital loading with clopidogrel (n = 1,532) - a TIMI-flow 3 at initial angiography was absent in 71.7 %, 69.0 % and 71.5 % of patients, respectively. Major adverse cardiac event (MACE) rates were low at 30 days (3.4 % to 4.0 %) and did not significantly differ between the different P2Y12 inhibitor regimens. In conclusion, this large observational, non-randomised study is the first to show that prehospital loading with the newer P2Y12 inhibitors does not improve early coronary reperfusion as compared to prehospital loading with clopidogrel in a PPCI cohort excluding cardiac arrest and cardiogenic shock.
authors.affiliation: Ole De Backer, MD, PhD, Kardiologisk klinik B 2012, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark, Tel.: +45 35457086, E-mail: ole.debacker@gmail.com.
authors.forename: Ole
authors.initials: O
authors.lastname: De Backer
authors.forename: Hanna
authors.initials: H
authors.lastname: Ratcovich
authors.forename: Luigi
authors.initials: L
authors.lastname: Biasco
authors.forename: Frants
authors.initials: F
authors.lastname: Pedersen
authors.forename: Steffen
authors.initials: S
authors.lastname: Helqvist
authors.forename: Kari
authors.initials: K
authors.lastname: Saunamäki
authors.forename: Hans-Henrik
authors.initials: HH
authors.lastname: Tilsted
authors.forename: Peter
authors.initials: P
authors.lastname: Clemmensen
authors.forename: Goran
authors.initials: G
authors.lastname: Olivecrona
authors.forename: Henning
authors.initials: H
authors.lastname: Kelbaek
authors.forename: Erik
authors.initials: E
authors.lastname: Jørgensen
authors.forename: Thomas
authors.initials: T
authors.lastname: Engstrøm
authors.forename: Lene
authors.initials: L
authors.lastname: Holmvang
mesh_terms: D000241:Adenosine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D000368:Aged; D000077144:Clopidogrel; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000187:drug effects; D004334:Drug Administration Schedule; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D000068799:Prasugrel Hydrochloride / Q000008:administration & dosage* / Q000009:adverse effects; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage*; D000077486:Ticagrelor; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine
keywords: ST-elevation myocardial infarction; antiplatelet therapy; coronary reperfusion; pretreatment