Prehospital ticagrelor in ST-segment elevation myocardial infarction
Gilles Montalescot1, Arnoud W van 't Hof, Frédéric Lapostolle
1The authors' affiliations are listed in the Appendix.
The New England Journal of Medicine
|September 2, 2014
Summary
Prehospital ticagrelor for ST-segment elevation myocardial infarction (STEMI) is safe but does not improve early reperfusion. This study found no significant difference in primary outcomes between prehospital and in-hospital administration.
Area of Science:
- Cardiology
- Clinical Trials
- Pharmacology
Background:
- Ticagrelor, a P2Y12 inhibitor, reduces adverse cardiovascular events in STEMI patients.
- The benefit of prehospital ticagrelor administration on coronary reperfusion and outcomes is not established.
Purpose of the Study:
- To evaluate the efficacy and safety of prehospital versus in-hospital ticagrelor administration in STEMI patients.
- To assess the impact on ST-segment elevation resolution and coronary artery flow before percutaneous coronary intervention (PCI).
Main Methods:
- International, randomized, double-blind study of 1862 STEMI patients.
- Compared prehospital (ambulance) versus in-hospital ticagrelor administration.
- Coprimary end points: ST-segment elevation resolution and Thrombolysis in Myocardial Infarction (TIMI) flow grade 3 before PCI.
Main Results:
- No significant difference in coprimary end points between prehospital and in-hospital groups.
- Major adverse cardiovascular events rates were similar.
- Definite stent thrombosis rates were lower in the prehospital group at 30 days (0.2% vs 1.2%).
- Major bleeding events were low and comparable between groups.
Conclusions:
- Prehospital ticagrelor administration in acute STEMI is safe.
- It did not improve pre-PCI coronary reperfusion.
- Further research may explore its role in specific patient subgroups.
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