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Am Heart J. 2018 Feb;196:1-8. doi: 10.1016/j.ahj.2017.09.018. Epub 2017 Oct 3.

Thrombus aspiration and prehospital ticagrelor administration in ST-elevation myocardial infarction: Findings from the ATLANTIC trial.

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Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands.
Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands; Department of Interventional Cardiology, Maastricht University Medical Centre+, Maastricht, the Netherlands. Electronic address:
Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany.
Service d'Aide Médicale Urgente 93, Hôpital Avicenne, Bobigny, France.
Department of Cardiology, Aarhus University Hospital, Skejby, Denmark.
AstraZeneca, La Défense, France.
Unité de Recherche Clinique Lariboisière, St Louis Hôpital Fernand Widal, ACTION study group, Assistance Publique Hôpitaux de Paris Université Paris-Diderot, Paris, France.
Sorbonne Université Paris VI, ACTION Study Group, Pitié-Salpêtrière Hospital, INSERM Unité Mixte de Recherche Scientifique, 1166, Paris, France.



The potential interactions between prehospital (pre-H) ticagrelor administration and thrombus aspiration (TA) in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) have never been studied. Therefore, we evaluated the potential benefit of TA and pre-H ticagrelor treatment in patients enrolled in the ATLANTIC trial (NCT01347580).


This analysis included 1,630 patients who underwent primary PCI. Multivariate analysis was used to explore the potential association of TA and pre-H treatment to clinical outcomes. Potential interactions between TA and pre-H ticagrelor were also explored.


A total of 941 (57.7%) patients underwent TA. In adjusted multivariate logistic model, pre-H ticagrelor treatment was significantly associated with less frequent new MI or definite stent *thrombosis (ST) (odds ratio [OR] 0.43, 95% CI 0.20-0.92, P=.031), or definite ST (OR 0.26, 95% CI 0.07-0.91, P=.036) at 30 days. Patients treated with TA had higher frequency of Thrombolysis in Myocardial Infarction (TIMI) flow 0-1 compared with no-TA group (80.7% vs 51.9%, P<.0001). TA when also adjusted for TIMI flow 0-1 showed significant association only for higher bailout use of glycoprotein IIb/IIIa inhibitors (OR 1.72, 95% CI 1.18-2.50, P=.004) and more frequent 30-day TIMI major bleeding (OR 2.92, 95% CI 1.10-7.76, P=.032). No significant interactions between TA and pre-H ticagrelor were present for the explored end points.


TA when left to physicians' discretion was used in high-risk patients, was associated with bailout use of glycoprotein IIb/IIIa inhibitors and TIMI major bleeding, and had no impact on 30-day clinical outcomes. Conversely, pre-H ticagrelor treatment predicted lower 30-day rates of ST or new MI without interaction with TA.

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