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Pre-Percutaneous Coronary Intervention TIMI Flow Grade in STEMI Patients Treated with Pre-Hospital Ticagrelor Loading

S Suleiman1, J J Coughlan2, S Arockiam2

  • 1Tallaght University Hospital1, Tallaght, Dublin 24, Ireland.

Irish Medical Journal
|May 9, 2022
PubMed

Insights

Pre-hospital ticagrelor loading in STEMI patients showed over one-fifth achieving TIMI flow grade 3 before PCI. This outcome is comparable to previous studies using clopidogrel.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Pharmacology

Background:

  • ST-elevation myocardial infarction (STEMI) requires rapid reperfusion.
  • Pre-hospital antiplatelet therapy aims to improve outcomes.
  • Ticagrelor is a P2Y12 inhibitor used in STEMI management.

Purpose of the Study:

  • To evaluate the proportion of STEMI patients achieving TIMI flow grade 3 pre-PCI with pre-hospital ticagrelor loading.
  • To compare these results with historical data from the clopidogrel era.

Main Methods:

  • Retrospective observational analysis of STEMI patients from 01/01/2016 to 31/12/2019.
  • Inclusion criteria: STEMI patients receiving pre-hospital 180 mg ticagrelor loading.
  • Assessment of pre-PCI TIMI flow grade (ppTFG) in the infarct-related artery via coronary angiography.

Main Results:

  • 590 patients met inclusion criteria.
  • 21.2% (125 patients) presented with ppTFG 3.
  • 78.8% (465 patients) presented with ppTFG ≤ 2.
  • In-hospital mortality was similar between groups (4% vs 5.6%, p=0.48).

Conclusions:

  • Over one-fifth of STEMI patients pre-loaded with ticagrelor achieved ppTFG 3.
  • This finding is comparable to historical data from the clopidogrel era.
  • Pre-hospital ticagrelor demonstrates a similar rate of early coronary artery patency in STEMI patients.

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