Pre-hospital ticagrelor in patients with ST-segment elevation myocardial infarction with long transport time to primary PCI facility.
BACKGROUND
Pre-hospital ticagrelor, given less than 1h before coronary intervention (PCI), failed to improve coronary reperfusion in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary PCI. It is unknown whether a longer interval from ticagrelor administration to primary PCI might reveal any improvement of coronary reperfusion.


METHODS
We retrospectively compared 143 patients, pre-treated in spoke centers or ambulance with ticagrelor at least 1.5h before PCI (Pre-treatment Group), with 143 propensity score-matched controls treated with ticagrelor in the hub before primary PCI (Control Group) extracted from RENOVAMI, a large observational Italian registry of more than 1400 STEMI patients enrolled from Jan. 2012 to Oct. 2015 (ClinicalTrials.gov id: NCT01347580). The median time from ticagrelor administration and PCI was 2.08h (95% CI 1.66-2.84) in the Pre-treatment Group and 0.56h (95% CI 0.33-0.76) in the Control Group. TIMI flow grade before primary PCI in the infarct related artery was the primary endpoint.


RESULTS
The primary endpoint, baseline TIMI flow grade, was significantly higher in Pre-treatment Group (0.88±1.14 vs 0.53±0.86, P=0.02). However in-hospital mortality, in-hospital stent thrombosis, bleeding rates and other clinical and angiographic outcomes were similar in the two groups.


CONCLUSIONS
In a real world STEMI network, pre-treatment with ticagrelor in spoke hospitals or in ambulance loading at least 1.5h before primary PCI is safe and might improve pre-PCI coronary reperfusion, in comparison with ticagrelor administration immediately before PCI.
2nd Cardiology Division, AOU Maggiore della Carità, Novara, Italy; Cardiology Clinic, Eastern Piedmont University, AOU Maggiore della Carità, Novara, Italy. Electronic address: lupialessandro1@gmail.com.
Alessandro
A
Lupi
Cardiology Clinic, Eastern Piedmont University, AOU Maggiore della Carità, Novara, Italy.
Alon
A
Schaffer
2nd Cardiology Division, AOU Maggiore della Carità, Novara, Italy.
Maurizio
M
Lazzero
Division of Cardiology, ASL VCO, Domodossola, Italy.
Massimo
M
Tessitori
Division of Cardiology, ASL VCO, Domodossola, Italy.
Leonardo
L
De Martino
2nd Cardiology Division, AOU Maggiore della Carità, Novara, Italy.
Andrea
A
Rognoni
2nd Cardiology Division, AOU Maggiore della Carità, Novara, Italy.
Angelo S
AS
Bongo
Division of Interventional Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
Italo
I
Porto
D000241:Adenosine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D000368:Aged; D000552:Ambulances; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000209:etiology; D004562:Electrocardiography; D004632:Emergency Medical Services; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D057216:Propensity Score; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D015607:Stents; D000077486:Ticagrelor; D013997:Time Factors; D061665:Time-to-Treatment; D014187:Transportation of Patients; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors; D000077486:Ticagrelor; D000241:Adenosine
ST elevation myocardial infarction; acute coronary syndrome; antiplatelet therapy; primary PCI; ticagrelor