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Int J Cardiol. 2017 Oct 1;244:49-53. doi: 10.1016/j.ijcard.2017.06.009. Epub 2017 Jun 9.

Pre-hospital ticagrelor in ST-segment elevation myocardial infarction in the French ATLANTIC population.

Author information

1
Department of Cardiology, CHU Caremeau, Université de Montpellier, Nîmes, France. Electronic address: guillaume.cayla@chu-nimes.fr.
2
SAMU 93, Hôpital Avicenne, Bobigny, France.
3
SMUR Pitié Salpêtrière, Paris, France.
4
Brigade des Sapeurs Pompiers, Paris, France.
5
SAMU, CHU Caremeau, Nimes, France.
6
Service de cardiologie, Lariboisière, Paris, France.
7
Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
8
Department of Cardiology B, Aarhus University Hospital, Skejby, Aarhus N, Denmark.
9
Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.
10
Department of Cardiology, St Antonius Hospital Nieuwegein, Nieuwegein, Netherlands.
11
Department of Cardiology, Kerckhoff Heart Center, Bad Neuheim, Germany.
12
Department of Cardiology, Isala Clinics, Zwolle, Netherlands.
13
Sorbonne Université Paris 6, ACTION Study Group, Institut de Cardiologie (AP-HP), CHU Pitié-Salpêtrière, INSERM UMRS, 1166 Paris, France.

Abstract

BACKGROUND:

ATLANTIC was a randomized study comparing pre- and in-hospital treatment with a ticagrelor loading dose (LD) in ongoing ST-segment elevation myocardial infarction (STEMI). We sought to compare patient characteristics and clinical outcomes in France with other countries participating in ATLANTIC.

METHODS:

The population comprised 1862 patients, 660 (35.4%) from France and 1202 from 12 other countries. The main endpoints were reperfusion (≥70% ST-segment elevation resolution) and TIMI flow grade 3 before (co-primary endpoints) and after percutaneous coronary intervention (PCI). Other endpoints included a composite ischaemic endpoint (death/myocardial infarction/stroke/urgent revascularization/definite stent thrombosis) and bleeding events at 30days.

RESULTS:

In France, median times from first LD to angiography and between first and second LDs were 49 and 35min, respectively, and were similar to other countries. French patients were younger (mean 58.7 vs 61.9years, p<0.0001) and characterized by a higher rate of radial access (89.9% vs 54.8%, p<0.0001), more frequent use of pre-hospital glycoprotein (GP) IIb/IIIa inhibitors (14.1% vs 3.1%, p<0.0001) and intravenous enoxaparin (57.3% vs 10.1%, p<0.0001). In France, as in other countries, the co-primary endpoints did not differ between the two randomization groups. The composite ischaemic endpoint was numerically lower in France (3.3% vs 5.1%, p=0.07), with a lower mortality (1.4% vs 3.3%, p=0.01). PLATO major bleeding was numerically less frequent in France (1.8% vs 3.2%, p=0.07).

CONCLUSIONS:

The French population appears to have better outcomes than the rest of the study population, and seems related to differences in demographics and management characteristics.

TRIAL REGISTRY:

ClinicalTrials.gov (NCT01347580).

KEYWORDS:

Acute coronary syndrome; ST-segment elevation myocardial infarction; Ticagrelor

PMID:
28622941
DOI:
10.1016/j.ijcard.2017.06.009
[Indexed for MEDLINE]

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