title: Impact of presentation and transfer delays on complete ST-segment resolution before primary percutaneous coronary intervention: insights from the ATLANTIC trial.
abstract: OBJECTIVE
  The aim of this study was to identify predictors of complete ST-segment resolution (STR) pre-primary percutaneous coronary intervention (PCI) in patients enrolled in the ATLANTIC trial.
  
  
  RESULTS
  ECGs recorded at the time of inclusion (pre-hospital [pre-H]-ECG) and in the catheterisation laboratory before angiography (pre-PCI-ECG) were analysed by an independent core laboratory. Complete STR was defined as ≥70%. Complete STR occurred pre-PCI in 12.8% (204/1,598) of patients and predicted lower 30-day composite MACCE (OR=0.10, 95% CI: 0.002-0.57, p=0.001) and total mortality (OR=0.16, 95% CI: 0.004-0.95, p=0.035). Independent predictors of complete STR included the time from index event to pre-H-ECG (OR=0.94, 95% CI: 0.89-1.00, p=0.035), use of heparins before pre-PCI-ECG (OR=1.75, 95% CI: 1.25-2.45, p=0.001) and time from pre-H-ECG to pre-PCI-ECG (OR=1.09, 95% CI: 1.03-1.16, p=0.005). In the pre-H ticagrelor group, patients with complete STR had a significantly longer delay between pre-H-ECG and pre-PCI-ECG compared to patients without complete STR (median 53 [44-73] vs. 49 [38.5-61] mins, p=0.001); however, this was not observed in the control group (in-hospital ticagrelor) (50 [40-67] vs. 49 [39-61] mins, p=0.258).
  
  
  CONCLUSIONS
  Short patient delay, early administration of anticoagulant and ticagrelor if a long transfer delay is expected may help to achieve reperfusion prior to PCI. Pre-H treatment may be beneficial in patients with longer transfer delays, allowing the drug to become biologically active.
authors.affiliation: Cardiology Department, Isala Clinics, Zwolle, the Netherlands.
authors.forename: Enrico
authors.initials: E
authors.lastname: Fabris
authors.forename: Arnoud
authors.initials: A
authors.lastname: Van't Hof
authors.forename: Christian W
authors.initials: CW
authors.lastname: Hamm
authors.forename: Frédéric
authors.initials: F
authors.lastname: Lapostolle
authors.forename: Jens Flensted
authors.initials: JF
authors.lastname: Lassen
authors.forename: Shaun G
authors.initials: SG
authors.lastname: Goodman
authors.forename: Jurriën M
authors.initials: JM
authors.lastname: Ten Berg
authors.forename: Leonardo
authors.initials: L
authors.lastname: Bolognese
authors.forename: Angel
authors.initials: A
authors.lastname: Cequier
authors.forename: Mohamed
authors.initials: M
authors.lastname: Chettibi
authors.forename: Christopher H
authors.initials: CH
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: Warren J
authors.initials: WJ
authors.lastname: Cantor
authors.forename: Hélène
authors.initials: H
authors.lastname: Rousseau
authors.forename: Eric
authors.initials: E
authors.lastname: Vicaut
authors.forename: Gilles
authors.initials: G
authors.lastname: Montalescot
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D004562:Electrocardiography / Q000379:methods; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000379:methods; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors