The platelet P2Y12 receptor antagonist ticagrelor is shown to reduce the incidence of cardiovascular events when administered in hospital admission to patients suffering an ST-segment elevation acute myocardial infarction. Pre-hospital management that could improve coronary reperfusion and events like death or stent thrombosis was not studied. 1862 patients were included suffering ST-segment elevation acute myocardial infarction within 6 hours of onset of symptoms and were randomized to receive ticagrelor pre-hospital (in the ambulance) versus intra-hospital (in the cath lab). No significant differences between the two strategies such in clinical events as in the ST-segment resolution after angioplasty were observed. There was only a difference in the rate of stent thrombosis, both within the first 24 hours (0% versus 0.8%) and first 30 days (0.2% versus 1.2%) in favor of pre-hospital administration. Bleeding events were virtually identical between groups beyond the definition used.
Gilles Montalescot
2014-09-01
Original title: In-ambulance versus in-cath lab administration of ticagrelor in STEMI patients transferred for primary PCI: the randomized, double-blind ATLANTIC study.
