Effect of Pre-Hospital Ticagrelor During the First 24 h After Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction: The ATLANTIC-H²⁴ Analysis

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• 作者：Gilles Montalescot ; MD ; PhD^a ; ^{gilles.montalescot@psl.aphp.fr" class="auth_mail" title="E-mail the corresponding author} ; Arnoud W. van &rsquo ; t Hof ; MD ; PhD^b ; Leonardo Bolognese ; MD^c ; Warren J. Cantor ; MD^d ; Angel Cequier ; MD ; PhD^e ; Mohamed Chettibi ; MD ; PhD^f ; Jean-Philippe Collet ; MD ; PhD^a ; Shaun G. Goodman ; MD^g ; Christopher J. Hammett ; MB ; ChB^h ; Kurt Huber ; MDⁱ ; Magnus Janzon ; MD ; PhD^j ; Fré ; dé ; ric Lapostolle ; MD ; PhD^k ; Jens Flensted Lassen ; MD ; PhD^l ; Muriel Licour ; MSc^m ; Bé ; la Merkely ; MD ; PhDⁿ ; Né ; joua Salhi ; MD^o ; Johanne Silvain ; MD ; PhD^a ; Robert F. Storey ; MD ; DM^p ; Jurrië ; n M. ten Berg ; MD ; PhD^q ; Anne Tsatsaris ; MD^m ; Uwe Zeymer ; MD^r ; Eric Vicaut ; MD ; PhD^s ; Christian W. Hamm ; MD ; PhD^t ; for the ATLANTIC InvestigatorsRachid Bougherbal ; Mohamed Tahar Bouafia ; Mohamed Chettibi ; Djamaleddine Nibouche ; Abdelkader Moklati ; Ahmed Benalia ; Omar Kaid ; Messaad Krim ; Christopher Hammett ; Paul Garrahy ; Rohan Jayasinghe ; Stephen Rashford ; Kurt Huber ; Thomas Neunteufl ; Helmut Brussee ; Hannes Alber ; Franz Weidinger ; Michael Brunner ; Johann Sipoetz ; Gerhard Prause ; Michael Baubin ; Dieter Sebald ; Warren Cantor ; Ram Vijayaraghavan ; Iqbal Bata ; Andrea Lavoie ; Jens Flensted Lassen ; Jan Ravkilde ; Lisette Okkels Jensen ; Alf Mø ; l Christensen ; Marianne Toftegaard ; Dennis Kö ; hler ; Gilles Montalescot ; Gregory Ducrocq ; Nicolas Danchin ; Patrick Henry ; Bernard Livarek ; Romain Berthier ; Thomas Hovasse ; Philippe Garot ; Laurent Payot ; Hakim Benamer ; Jean Baptiste Esteve ; Simon Elhadad ; Emmanuel Teiger ; Jean Louis Bonnet ; Franck Paganelli ; Yves Cottin ; Franç ; ois Schiele ; Christophe Thuaire ; Guillaume Cayla ; Pierre Coste ; Patrick Ohlmann ; Eric Bonnefoy Cudraz ; Pierre Lantelme ; Thibault Perret ; Christophe Tron ; Axel De Labriolle ; Edouardo Aptecar ; Olivier Beliard ; Olivier Varenne ; Rami El Mahmoud ; Emmanuelle Filippi-Codaccioni ; Denis Angoulvant ; Patrick Peycher ; Olivier Poitrineau ; Xavier Tabone ; Patrick Ecollan ; Claire Broche ; Yves Lambert ; Nicolas Briole ; Arielle Beruben ; Nicolas Porcher ; Jean-Pierre Auffray ; Marc Freysz ; Franck Depardieu ; David Poubel ; Jean-Emmanuel De La Cousaye ; Jean-Claude Bartier ; Benoî ; t Jardel ; Bertrand Boulanger ; Hervé ; Labourel ; Louis-Christophe Soulat ; Fré ; dé ; ric Lapostolle ; Vé ; ronique Julie ; Michel Thicoipe ; Olivier Capel ; Olivier Stibbe ; Pierre Carli ; Karim Tazarourte ; Fabrice Alcouffe ; David Aboucaya ; Gaë ; le Aubert ; Gé ; rald Kierzek ; Sé ; verine Cahun-Giraud ; Uwe Zeymer ; Christian Hamm ; Thomas Dengler ; Roland Prondzinsky ; Paul Marc Biever ; Andreas Schä ; fer ; Melchior Seyfarth ; Bernd Lemke ; Gerald Werner ; Holger Nef ; Holger Steiger ; Matthias Leschke ; Thomas Mü ; nzel ; Marco Campo Dell Orto ; Christian Loges ; Monika Schinke ; Frank Koberne ; Hans Peter Reiffen ; Klaus Tiroch ; Dirk Wierich ; Michael Kneussel ; Simon Little ; Hartmut Sauer ; Rita Laufenberg-Feldmann ; Bé ; la Merkely ; Imre Ungi ; Ivá ; n Horvá ; th ; Istvá ; n É ; des ; Istvá ; n Má ; rtai ; Leonardo Bolognese ; Sergio Berti ; Francesco Chiarella ; Paolo Calabria ; Massimo Fineschi ; Marcello Galvani ; Marco Valgimigli ; Luciano Moretti ; Maurizio Tespili ; Massimo Mandó ; Francesco Bermano ; Robusto Biagioni ; Andrea Fabbri ; Adelina Ricciardelli ; Maria Romana Petroni ; Umberto Roberto Vatteroni ; Francesco Palumbo ; Frank F. Willems ; Amar Al Mafragi ; Ton A.A.C.M. Heestermans ; Martijn J. Van Eck ; Wim M.J.M. Heutz ; H.H. Meppelder ; Anika Roukema-de Jong ; Harm Van de Pas ; Á ; ngel Cequier Fillat ; Manel Sabaté ; Tenas ; Josepa Mauri Ferrer ; Antoni Serra Peñ ; aranda ; Joan Á ; ngel Ferrer ; Bruno Garcí ; a Del Blanco ; Faustino Miranda Guardiola ; Juan Miguel Ruiz Nodar ; André ; s Í ; ñ ; iguez Romo ; Nicolá ; s Vá ; zquez Gonzá ; lez ; Ramiro Trillo Nouche ; Luis Dí ; az De La Llera ; José ; Marí ; a Herná ; ndez Garcí ; a ; Fernando Rivero-Crespo ; Felipe Herná ; ndez Herná ; ndez ; José ; Luis Zamorano Gó ; mez ; Xavier Jimé ; nez Fá ; rega ; Gilberto Alonso Ferná ; ndez ; José ; Luis Toboso ; Mercedes Carrasco ; Victoria Barreiro ; José ; Antonio Iglesias Vá ; zquez ; Marí ; a del Mar Ruiz Montero ; Fernando Rosell Ortiz ; Guillermo Garcia Escudero ; Vicente Sá ; nchez-Brunete Ingelmo ; Antonio Lara Garcí ; a ; Magnus Janzon ; Jonas Oldgren ; Fredrik Calais ; Robert Kastberg ; Per-Adolf Bergsten ; Hans Blomberg ; Kristian Thö ; rn ; Gunnar Skoog ; Robert F. Storey ; Azfar Zaman ; Robert Gerber ; Alisdair Ryding ; Mark Spence ; Neil Swanson ; Martin Been ; Konrad Grosser ; Peter Schofield ; David Mackin ; Paul Fell ; Tom Quinn ; Teresa Foster ; David McManus ; Andy Carson
• 关键词：myocardial infarction ; platelets ; reperfusion ; stents ; thrombosis
• 刊名：JACC: Cardiovascular Interventions
• 出版年：2016
• 出版时间：11 April 2016
• 年：2016
• 卷：9
• 期：7
• 页码：646-656
• 全文大小：790 K

文摘

The aim of this landmark exploratory analysis, ATLANTIC-H²⁴, was to evaluate the effects of pre-hospital ticagrelor during the first 24 h after primary percutaneous coronary intervention (PCI) in the ATLANTIC (Administration of Ticagrelor in the cath Lab or in the Ambulance for New ST elevation myocardial infarction to open the Coronary artery) study.

Background

The ATLANTIC trial in patients with ongoing ST-segment elevation myocardial infarction showed that pre-hospital ticagrelor was safe but did not improve pre-PCI coronary reperfusion compared with in-hospital ticagrelor. We hypothesized that the effect of pre-hospital ticagrelor may not have manifested until after PCI due to the rapid transfer time (31 min).

Methods

The ATLANTIC-H²⁴ analysis included 1,629 patients who underwent PCI, evaluating platelet reactivity, Thrombolysis In Myocardial Infarction flow grade 3, ≥70% ST-segment elevation resolution, and clinical endpoints over the first 24 h.

Results

Following PCI, largest between-group differences in platelet reactivity occurred at 1 to 6 h; coronary reperfusion rates numerically favored pre-hospital ticagrelor, and the degree of ST-segment elevation resolution was significantly greater in the pre-hospital group (median, 75.0% vs. 71.4%; p = 0.049). At 24 h, the composite ischemic endpoint was lower with pre-hospital ticagrelor (10.4% vs. 13.7%; p = 0.039), as were individual endpoints of definite stent thrombosis (p = 0.0078) and myocardial infarction (p = 0.031). All endpoints except death (1.1% vs. 0.2%; p = 0.048) favored pre-hospital ticagrelor, with no differences in bleeding events.

Conclusions

The effects of pre-hospital ticagrelor became apparent after PCI, with numerical differences in platelet reactivity and immediate post-PCI reperfusion, associated with reductions in ischemic endpoints, over the first 24 h, whereas there was a small excess of mortality. (Administration of Ticagrelor in the cath Lab or in the Ambulance for New ST elevation myocardial infarction to open the Coronary artery [ATLANTIC, NCT01347580])