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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.

Author information

1
Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands.
2
Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands; Department of Interventional Cardiology, Maastricht University Medical Centre+, Maastricht, the Netherlands. Electronic address: v.r.c.derks@isala.nl.
3
Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany.
4
Service d'Aide Médicale Urgente 93, Hôpital Avicenne, Bobigny, France.
5
Department of Cardiology, Aarhus University Hospital, Skejby, Denmark.
6
AstraZeneca, La Défense, France.
7
Unité de Recherche Clinique Lariboisière, St Louis Hôpital Fernand Widal, ACTION study group, Assistance Publique Hôpitaux de Paris Université Paris-Diderot, Paris, France.
8
Sorbonne Université Paris VI, ACTION Study Group, Pitié-Salpêtrière Hospital, INSERM Unité Mixte de Recherche Scientifique, 1166, Paris, France.

Abstract

BACKGROUND:

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).

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

PMID:
29421001
DOI:
10.1016/j.ahj.2017.09.018
[Indexed for MEDLINE]
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