Portal de Periódicos da CAPES

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

2016; Elsevier BV; Volume: 9; Issue: 7 Linguagem: Inglês

10.1016/j.jcin.2015.12.024

1936-8798

Gilles Montalescot, Arnoud W.J. van ‘t Hof, Leonardo Bolognese, Warren J. Cantor, Ángel Cequier, Mohamed Chettibi, Jean‐Philippe Collet, Shaun G. Goodman, Christopher 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, Éric Vicaut, C Hamm, R. Bougherbal, M.T. Bouafia, Mohamed Chettibi, Djamaleddine Nibouche, Abdelkader Moklati, Ahmed Benalia, Omar Kaid, Messaad Krim, Christopher Hammett, P. 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 J. Cantor, Ram Vijayaraghavan, Iqbal Bata, Andrea Lavoie, Jens Flensted Lassen, Jan Ravkilde, Lisette Okkels Jensen, Alex Hørby Christensen, Marianne Toftegaard, D Köhler, Gilles Montalescot, Grégory Ducrocq, Nicolas Danchin, Patrick Henry, B. Livarek, Romain Berthier, Thomas Hovasse, Philippe Garot, Laurent Payot, Hakim Benamer, Jean Baptiste Esteve, Simon Elhadad, Emmanuel Teíger, Jean Louis Bonnet, Franck Paganelli, Yves Cottin, François Schiele, Christophe Thuaire, Guillaume Cayla, Pierre Coste, Patrick Ohlmann, Eric Bonnefoy Cudraz, Pierre Lantelme, Thibault Perret, Christophe Tron, Axel de Labriolle, Eduardo Aptecar, Olivier Beliard, Olivier Varenne, Rami El Mahmoud, Emmanuelle Filippi‐Codaccioni, Denis Angoulvant, Patrick Peycher, O Poitrineau, X Tabone, Patrick Ecollan, C. Broche, Yves Lambert, Nicolas Briole, Arielle Beruben, Nicolas Porcher, Jean‐Pierre Auffray, M. Freysz, F. Depardieu, David Poubel, Jean-Emmanuel De La Cousaye, Jean-Claude Bartier, B. Jardel, Bertrand Boulanger, Hervé Labourel, Louis Soulat, Frédéric Lapostolle, V. Julié, M. Thicoïpé, Olivier Capel, Olivier Stibbe, Pierre Carli, Karim Tazarourte, Fabrice Alcouffe, David Aboucaya, Gabriel Aubert, G. Kierzek, S. Cahun-Giraud, Uwe Zeymer, Christian Hamm, Thomas J. Dengler, Roland Prondzinsky, Paul Biever, Andreas Schäfer, Melchior Seyfarth, Bernd Lemke, Gerald Werner, Holger Nef, Holger Steiger, Matthias Leschke, Thomas Münzel, Marco Campo dell’ Orto, Christian Loges, Martina Schinke, Frank Koberne, Hans-Peter Reiffen, Klaus Tiroch, Dirk Wierich, Matthias Kneussel, Simon Little, Hartmut Sauer, Rita Laufenberg–Feldmann, Béla Merkely, Imre Ungi, Iván Horváth, István Édes, István Mártai, Leonardo Bolognese, Sergio Berti, Francesco Chiarella, Paolo Calabria, Massimo Fineschi, Marcello Galvani, Marco Valgimigli, Luciano Moretti, Maurizio Tespili, Massimo Mandò, Francesco Bermano, Rodrigo Bruno Biagioni, Andrea Fabbri, Adelina Ricciardelli, Maria Letizia Petroni, Umberto Roberto Vatteroni, Francesco Palumbo, Frank F. Willems, Amar Al Mafragi, Ton Heestermans, Miranda Van Eck, Wim M.J.M. Heutz, H.H. Meppelder, Andy Jong, Hendri H. Pas, Ángel Cequier, Manel Sabaté, J.M. Escribano Ferrer, Antoni Serra Peñaranda, Jaume Ferrer, Bruno García del Blanco, Faustino Miranda Guardiola, Juan Miguel Ruiz Nodar, Andrés Íñiguez, Nicolas Vázquez González, Ramiro Trillo, Luis S. Díaz de la Llera, José Marı́a Hernández Garcı́a, Fernando Rivero‐Crespo, Felipe Hernández, José Luis Zamorano Gómez, Xavier Jiménez Fárega, G Fernandez, José Luis Toboso, Maria Clara Carrasco, V. Mauriz Barreiro, José Antonio Iglesias Vázquez, María Jesús Miranda Montero, Fernando Rosell Ortiz, Gabriela Escudero, Vicente Sánchez-Brunete, Antonio Lara García, Magnus Janzon, Jonas Oldgren, Fredrik Calais, Robert Kastberg, Per-Adolf Bergsten, Hans Blomberg, Kristian Thörn, Gunnar Skoog, Robert F. Storey, Azfar Zaman, Robert Gerber, Alisdair Ryding, Mark Spence, Neil Swanson, Martin Been, Konrad Großer, Peter M. Schofield, David Mackin, Patrick Fell, Tom Quinn, Timothy P. Foster, David McManus, Andy Carson,

Coronary Interventions and Diagnostics

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. 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). 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. 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. 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])