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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Thrombus aspiration and prehospital ticagrelor administration in ST-elevation myocardial infarction: Findings from
Sinem Kilic1, Enrico Fabris1, Arnoud W J Van't Hof2
1Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands.
Insights
Pre-hospital ticagrelor reduced stent thrombosis and myocardial infarction in STEMI patients. Thrombus aspiration did not show significant interactions with ticagrelor but was linked to increased bleeding risk.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Interactions between prehospital ticagrelor and thrombus aspiration in STEMI patients undergoing primary PCI remain unstudied.
- The ATLANTIC trial provides a dataset to investigate these potential effects.
Purpose of the Study:
- To evaluate the combined benefits of prehospital ticagrelor and thrombus aspiration in STEMI patients.
- To explore potential interactions between these two treatment strategies on clinical outcomes.
Main Methods:
- Analysis of 1,630 patients from the ATLANTIC trial undergoing primary PCI.
- Multivariate logistic regression to assess associations between thrombus aspiration, prehospital ticagrelor, and clinical outcomes.
- Exploration of interactions between thrombus aspiration and prehospital ticagrelor.
Main Results:
- Prehospital ticagrelor was associated with reduced rates of new myocardial infarction or definite stent thrombosis at 30 days.
- Thrombus aspiration was associated with higher rates of initial occluded arteries (TIMI flow 0-1) and increased 30-day major bleeding.
- No significant interactions were found between thrombus aspiration and prehospital ticagrelor for the studied endpoints.
Conclusions:
- Thrombus aspiration, used at physician discretion in high-risk patients, did not impact 30-day outcomes but increased bleeding risk.
- Prehospital ticagrelor independently predicted lower 30-day rates of stent thrombosis or new myocardial infarction.
- No synergistic or antagonistic interaction was observed between prehospital ticagrelor and thrombus aspiration.
Background:
The potential interactions between prehospital (pre-H) ticagrelor administration and thrombus aspiration (TA) in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) have never been studied. Therefore, we evaluated the potential benefit of TA and pre-H ticagrelor treatment in patients enrolled in the ATLANTIC trial (NCT01347580).
Methods:
This analysis included 1,630 patients who underwent primary PCI. Multivariate analysis was used to explore the potential association of TA and pre-H treatment to clinical outcomes. Potential interactions between TA and pre-H ticagrelor were also explored.
Results:
A total of 941 (57.7%) patients underwent TA. In adjusted multivariate logistic model, pre-H ticagrelor treatment was significantly associated with less frequent new MI or definite stent *thrombosis (ST) (odds ratio [OR] 0.43, 95% CI 0.20-0.92, P=.031), or definite ST (OR 0.26, 95% CI 0.07-0.91, P=.036) at 30 days. Patients treated with TA had higher frequency of Thrombolysis in Myocardial Infarction (TIMI) flow 0-1 compared with no-TA group (80.7% vs 51.9%, P<.0001). TA when also adjusted for TIMI flow 0-1 showed significant association only for higher bailout use of glycoprotein IIb/IIIa inhibitors (OR 1.72, 95% CI 1.18-2.50, P=.004) and more frequent 30-day TIMI major bleeding (OR 2.92, 95% CI 1.10-7.76, P=.032). No significant interactions between TA and pre-H ticagrelor were present for the explored end points.
Conclusions:
TA when left to physicians' discretion was used in high-risk patients, was associated with bailout use of glycoprotein IIb/IIIa inhibitors and TIMI major bleeding, and had no impact on 30-day clinical outcomes. Conversely, pre-H ticagrelor treatment predicted lower 30-day rates of ST or new MI without interaction with TA.
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