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

Gilles Montalescot; Arnoud W van 't Hof; Leonardo Bolognese; Warren J Cantor; Angel Cequier; Mohamed Chettibi; Jean-Philippe Collet; Shaun G Goodman; Christopher J Hammett; Kurt Huber; Magnus Janzon; Frédéric Lapostolle; Jens Flensted Lassen; Muriel Licour; Béla Merkely; Néjoua Salhi; Johanne Silvain; Robert F Storey; Jurriën M Ten Berg; Anne Tsatsaris; Uwe Zeymer; Eric Vicaut; Christian W Hamm; ATLANTIC Investigators

doi:10.1016/j.jcin.2015.12.024

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

Gilles Montalescot, Arnoud W van 't Hof, Leonardo Bolognese, Warren J Cantor, Angel Cequier, Mohamed Chettibi, Jean-Philippe Collet, Shaun G Goodman, Christopher J Hammett, Kurt Huber, Magnus Janzon, Frédéric Lapostolle, Jens Flensted Lassen, Muriel Licour, Béla Merkely, Néjoua Salhi, Johanne Silvain, Robert F Storey, Jurriën M Ten Berg, Anne TsatsarisUwe Zeymer, Eric Vicaut, Christian W Hamm, ATLANTIC Investigators

29 Citationer (Scopus)

Abstrakt

OBJECTIVES: The aim of this landmark exploratory analysis, ATLANTIC-H(24), 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-H(24) 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]).

Originalsprog	Engelsk
Tidsskrift	JACC: Cardiovascular Interventions
Vol/bind	9
Udgave nummer	7
Sider (fra-til)	646-56
Antal sider	11
ISSN	1936-8798
DOI	https://doi.org/10.1016/j.jcin.2015.12.024
Status	Udgivet - 11 apr. 2016

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10.1016/j.jcin.2015.12.024

Citationsformater

Montalescot, G., van 't Hof, A. W., Bolognese, L., Cantor, W. J., Cequier, A., Chettibi, M., Collet, J-P., Goodman, S. G., Hammett, C. J., Huber, K., Janzon, M., Lapostolle, F., Lassen, J. F., Licour, M., Merkely, B., Salhi, N., Silvain, J., Storey, R. F., Ten Berg, J. M., ... ATLANTIC Investigators (2016). 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. JACC: Cardiovascular Interventions, 9(7), 646-56. https://doi.org/10.1016/j.jcin.2015.12.024

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. / Montalescot, Gilles; van 't Hof, Arnoud W; Bolognese, Leonardo et al.

I: JACC: Cardiovascular Interventions, Bind 9, Nr. 7, 11.04.2016, s. 646-56.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Montalescot, G, van 't Hof, AW, Bolognese, L, Cantor, WJ, Cequier, A, Chettibi, M, Collet, J-P, Goodman, SG, Hammett, CJ, Huber, K, Janzon, M, Lapostolle, F, Lassen, JF, Licour, M, Merkely, B, Salhi, N, Silvain, J, Storey, RF, Ten Berg, JM, Tsatsaris, A, Zeymer, U, Vicaut, E, Hamm, CW & ATLANTIC Investigators 2016, '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', JACC: Cardiovascular Interventions, bind 9, nr. 7, s. 646-56. https://doi.org/10.1016/j.jcin.2015.12.024

Montalescot G, van 't Hof AW, Bolognese L, Cantor WJ, Cequier A, Chettibi M et al. 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. JACC: Cardiovascular Interventions. 2016 apr. 11;9(7):646-56. https://doi.org/10.1016/j.jcin.2015.12.024

@article{83149807ad9f4fe39ac3223953bbd904,

title = "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",

abstract = "OBJECTIVES: The aim of this landmark exploratory analysis, ATLANTIC-H(24), 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-H(24) 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]).",

keywords = "Adenosine, Adult, Aged, Ambulances, Coronary Thrombosis, Double-Blind Method, Emergency Medical Services, Female, Humans, Male, Middle Aged, Percutaneous Coronary Intervention, Platelet Aggregation, Platelet Aggregation Inhibitors, Platelet Function Tests, Recurrence, ST Elevation Myocardial Infarction, Time Factors, Time-to-Treatment, Treatment Outcome, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't",

author = "Gilles Montalescot and {van 't Hof}, {Arnoud W} and Leonardo Bolognese and Cantor, {Warren J} and Angel Cequier and Mohamed Chettibi and Jean-Philippe Collet and Goodman, {Shaun G} and Hammett, {Christopher J} and Kurt Huber and Magnus Janzon and Fr{\'e}d{\'e}ric Lapostolle and Lassen, {Jens Flensted} and Muriel Licour and B{\'e}la Merkely and N{\'e}joua Salhi and Johanne Silvain and Storey, {Robert F} and {Ten Berg}, {Jurri{\"e}n M} and Anne Tsatsaris and Uwe Zeymer and Eric Vicaut and Hamm, {Christian W} and {ATLANTIC Investigators}",

year = "2016",

month = apr,

day = "11",

doi = "10.1016/j.jcin.2015.12.024",

language = "English",

volume = "9",

pages = "646--56",

journal = "JACC: Cardiovascular Interventions",

issn = "1936-8798",

publisher = "Elsevier Inc",

number = "7",

}

TY - JOUR

T1 - Effect of Pre-Hospital Ticagrelor During the First 24 h After Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction

T2 - The ATLANTIC-H²⁴ Analysis

AU - Montalescot, Gilles

AU - van 't Hof, Arnoud W

AU - Bolognese, Leonardo

AU - Cantor, Warren J

AU - Cequier, Angel

AU - Chettibi, Mohamed

AU - Collet, Jean-Philippe

AU - Goodman, Shaun G

AU - Hammett, Christopher J

AU - Huber, Kurt

AU - Janzon, Magnus

AU - Lapostolle, Frédéric

AU - Lassen, Jens Flensted

AU - Licour, Muriel

AU - Merkely, Béla

AU - Salhi, Néjoua

AU - Silvain, Johanne

AU - Storey, Robert F

AU - Ten Berg, Jurriën M

AU - Tsatsaris, Anne

AU - Zeymer, Uwe

AU - Vicaut, Eric

AU - Hamm, Christian W

AU - ATLANTIC Investigators

PY - 2016/4/11

Y1 - 2016/4/11

N2 - OBJECTIVES: The aim of this landmark exploratory analysis, ATLANTIC-H(24), 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-H(24) 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]).

AB - OBJECTIVES: The aim of this landmark exploratory analysis, ATLANTIC-H(24), 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-H(24) 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]).

KW - Adenosine

KW - Adult

KW - Aged

KW - Ambulances

KW - Coronary Thrombosis

KW - Double-Blind Method

KW - Emergency Medical Services

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Percutaneous Coronary Intervention

KW - Platelet Aggregation

KW - Platelet Aggregation Inhibitors

KW - Platelet Function Tests

KW - Recurrence

KW - ST Elevation Myocardial Infarction

KW - Time Factors

KW - Time-to-Treatment

KW - Treatment Outcome

KW - Comparative Study

KW - Journal Article

KW - Multicenter Study

KW - Randomized Controlled Trial

KW - Research Support, Non-U.S. Gov't

U2 - 10.1016/j.jcin.2015.12.024

DO - 10.1016/j.jcin.2015.12.024

M3 - Journal article

C2 - 26952907

VL - 9

SP - 646

EP - 656

JO - JACC: Cardiovascular Interventions

JF - JACC: Cardiovascular Interventions

SN - 1936-8798

IS - 7

ER -

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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