Related Experiment Video
Updated: Feb 28, 2026
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
Pre-hospital ticagrelor in ST-segment elevation myocardial infarction in the French ATLANTIC population
Guillaume Cayla1, Frédéric Lapostolle2, Patrick Ecollan3
1Department of Cardiology, CHU Caremeau, Université de Montpellier, Nîmes, France.
Insights
French ST-segment elevation myocardial infarction patients in the ATLANTIC trial had better outcomes, likely due to younger demographics and distinct management strategies. This highlights potential improvements in STEMI care.
Area of Science:
- Cardiology
- Clinical Trials
- Pharmacology
Background:
- The ATLANTIC trial investigated pre- and in-hospital ticagrelor loading doses for ST-segment elevation myocardial infarction (STEMI).
- This analysis compares patient characteristics and clinical outcomes between France and other participating countries.
Purpose of the Study:
- To compare patient demographics and clinical outcomes in French STEMI patients versus those from other countries within the ATLANTIC study.
- To identify factors contributing to outcome differences between French and international STEMI populations.
Main Methods:
- A randomized study involving 1862 STEMI patients (660 from France).
- Co-primary endpoints included reperfusion and TIMI flow grade 3 before and after percutaneous coronary intervention (PCI).
- Secondary endpoints assessed ischemic events and bleeding at 30 days.
Main Results:
- French patients were younger and had higher rates of radial access, pre-hospital glycoprotein IIb/IIIa inhibitors, and enoxaparin use.
- While co-primary endpoints did not differ, the composite ischemic endpoint was numerically lower in France (3.3% vs. 5.1%).
- Mortality was significantly lower in France (1.4% vs. 3.3%, p=0.01), and major bleeding was numerically less frequent (1.8% vs. 3.2%).
Conclusions:
- The French STEMI population demonstrated better clinical outcomes compared to the international cohort.
- Demographic differences and distinct management characteristics likely contributed to the observed outcome variations.
- These findings suggest potential areas for optimizing STEMI treatment strategies globally.
Background:
ATLANTIC was a randomized study comparing pre- and in-hospital treatment with a ticagrelor loading dose (LD) in ongoing ST-segment elevation myocardial infarction (STEMI). We sought to compare patient characteristics and clinical outcomes in France with other countries participating in ATLANTIC.
Methods:
The population comprised 1862 patients, 660 (35.4%) from France and 1202 from 12 other countries. The main endpoints were reperfusion (≥70% ST-segment elevation resolution) and TIMI flow grade 3 before (co-primary endpoints) and after percutaneous coronary intervention (PCI). Other endpoints included a composite ischaemic endpoint (death/myocardial infarction/stroke/urgent revascularization/definite stent thrombosis) and bleeding events at 30days.
Results:
In France, median times from first LD to angiography and between first and second LDs were 49 and 35min, respectively, and were similar to other countries. French patients were younger (mean 58.7 vs 61.9years, p<0.0001) and characterized by a higher rate of radial access (89.9% vs 54.8%, p<0.0001), more frequent use of pre-hospital glycoprotein (GP) IIb/IIIa inhibitors (14.1% vs 3.1%, p<0.0001) and intravenous enoxaparin (57.3% vs 10.1%, p<0.0001). In France, as in other countries, the co-primary endpoints did not differ between the two randomization groups. The composite ischaemic endpoint was numerically lower in France (3.3% vs 5.1%, p=0.07), with a lower mortality (1.4% vs 3.3%, p=0.01). PLATO major bleeding was numerically less frequent in France (1.8% vs 3.2%, p=0.07).
Conclusions:
The French population appears to have better outcomes than the rest of the study population, and seems related to differences in demographics and management characteristics.
Trial Registry:
ClinicalTrials.gov (NCT01347580).
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management
01:25ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias