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Title: Prehospital ticagrelor in ST-segment elevation myocardial infarction
Author: Montalescot, G.
van't Hof, Arnoud W.
Lapostolle, Frédéric
Silvain, Johanne
Lassen, Jens Flensted
Bolognese, Leonardo
Cantor, Warren J.
Cequier Fillat, Àngel R.
Chettibi, Mohamed
Goodman, Shaun G.
Hammett, Christopher J.
Huber, Kurt
Janzon, Magnus
Merkely, Béla
Storey, Robert F.
Zeymer, Uwe
Stibbe, Olivier
Ecollan, Patrick
Heutz, Wim M.J.M.
Swahn, Eva
Collet, Jean-Philippe
Willems, Frank F.
Baradat, Caroline
Licour, Muriel
Tsatsaris, Anne
Vicaut, Eric
Hamm, C. W. (Christian W.)
Keywords: Infart de miocardi
Malalties coronàries
Anticoagulants (Medicina)
Myocardial infarction
Coronary diseases
Anticoagulants (Medicine)
Issue Date: 11-Sep-2014
Publisher: Massachusetts Medical Society
Abstract: Background:The direct-acting platelet P2Y 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
Note: Reproducció del document publicat a:
It is part of: New England Journal of Medicine, 2014, vol. 371, num. 11, p. 1016-1027
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ISSN: 0028-4793
Appears in Collections:Articles publicats en revistes (Ciències Clíniques)
Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))

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