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N Engl J Med. 2014 Sep 11;371(11):1016-27. doi: 10.1056/NEJMoa1407024. Epub 2014 Sep 1.

Prehospital ticagrelor in ST-segment elevation myocardial infarction.

Collaborators (235)

Bougherbal R, Bouafia MT, Chettibi M, Nibouche D, Moklati A, Benalia A, Kaid O, Krim M, Hammett C, Garraby P, Jayasinghe R, Rashford S, Huber K, Neunteufl T, Brussee H, Alber H, Weidinger F, Brunner M, Sipoetz J, Prause G, Baubin M, Sebald D, Cantor W, Vijayaraghavan R, Bata I, Lavoie A, Lassen JF, Ravkilde J, Jensen LO, Christensen AM, Toftegaard M, Köhler D, Montalescot G, Ducrocq G, Danchin N, Henry P, Livarek B, Berthier R, Hovasse T, Garot P, Payot L, Benamer H, Esteve JB, Elhadad S, Teiger E, Bonnet JL, Paganelli F, Cottin Y, Schiele F, Thuaire C, Cayla G, Coste P, Ohlmann P, Cudraz EB, Lantelme P, Perret T, Tron C, De Labriolle A, Aptecar E, Beliard O, Varenne O, El Mahmoud R, Filippi-Codaccioni E, Angoulvant D, Peycher P, Poitrineau O, Tabone X, Ecollan P, Broche C, Lambert Y, Briole N, Beruben A, Porcher N, Auffray JP, Freysz M, Depardieu F, Poubel D, De La Cousaye JE, Bartier JC, Jardel B, Boulanger B, Labourel H, Soulat LC, Lapostolle F, Julie V, Thicoipe M, Capel O, Stibbe O, Carli P, Tazarourte K, Alcouffe F, Aboucaya D, Aubert G, Kierzek G, Cahun-Giraud S, Zeymer U, Hamm C, Dengler T, Prondzinsky R, Biever PM, Schäfer A, Seyfarth M, Lemke B, Werner G, Nef H, Steiger H, Leschke M, Münzel T, Dell Orto MC, Loges C, Schinke M, Koberne F, Reiffen HP, Tiroch K, Wierich D, Kneussel M, Little S, Sauer H, Laufenberg-Feldmann R, Merkely B, Ungi I, Horváth I, Édes I, Mártai I, Bolognese L, Berti S, Chiarella F, Calabria P, Fineschi M, Galvani M, Valgimigli M, Moretti L, Tespili M, Mandó M, Bermano F, Biagioni R, Fabbri A, Ricciardelli A, Petroni MR, Vatteroni UR, Palumbo F, Willems FF, Al mafragi A, Heestermans TA, Van Eck MJ, Heutz WM, Meppelder HH, Roukema-de Jong A, Van de Pas H, Fillat ÁC, Tenas MS, Ferrer JM, Peñaranda AS, Ferrer JÁ, Del Blanco BG, Guardiola FM, Nodar JM, Romo AÍ, González NV, Nouche RT, De La Llera LD, García JM, Rivero-Crespo F, Hernández FH, Gómez JL, Fárega XJ, Fernández GA, Toboso JL, Carrasco M, Barreiro V, Vázquez JA, Montero Mdel M, Ortiz FR, Escudero GG, Ingelmo VS, García AL, Janzon M, Oldgren J, Calais F, Kastberg R, Bergsten PA, Blomberg H, Thörn K, Skoog G, Storey RF, Zaman A, Gerber R, Ryding A, Spence M, Swanson N, Been M, Grosser K, Schofield P, Mackin D, Fell P, Quinn T, Foster T, McManus D, Carson A, Wilcox R, Gray D, Smith W, Taylor T, Montalescot G, van't Hof AW, Hamm CW, Lapostolle F, Lassen JF, Baradat C, Licour M, Tsatsaris A, Montalescot G, van't Hof AW, Hamm CW, Lapostolle F, Lassen JF, Cantor WJ, ten Berg JM, Bolognese L, Cequier Á, Chettibi M, Goodman SG, Hammett CJ, Huber K, Janzon M, Merkely B, Storey RF, Zeymer U, Baradat C, Licour M, Salhi N, Tsatsaris A, Pocock S, Steg PG, Garcia AA.

Author information

1
The authors' affiliations are listed in the Appendix.

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.).

PMID:
25175921
DOI:
10.1056/NEJMoa1407024
[Indexed for MEDLINE]
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