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Impact of Prehospital Ticagrelor Loading Dose Combined With Aspirin Dual Antiplatelet Therapy on Post-PCI TIMI Flow
Pingwei Liu1, Guangsheng Cai2, Yanmei Wang3
1Xinping Yi and Dai Autonomous County People's Hospital, Yuxi City, Yunnan Province, China.
Insights
Administering ticagrelor and aspirin prehospital improves ST-elevation myocardial infarction (STEMI) reperfusion and reduces adverse events. This early dual antiplatelet therapy (DAPT) strategy shows superior outcomes without increased bleeding risk.
Area of Science:
- Cardiology
- Emergency Medicine
- Pharmacology
Background:
- Early dual antiplatelet therapy (DAPT) is crucial for ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI).
- Guidelines recommend prompt P2Y12 inhibitor use, but optimal timing (prehospital vs. in-hospital) for STEMI treatment is unclear.
Purpose of the Study:
- To evaluate if prehospital ticagrelor loading plus aspirin improves coronary reperfusion and outcomes in STEMI patients compared to in-hospital administration.
- To assess the impact of early DAPT on key clinical endpoints in STEMI management.
Main Methods:
- Retrospective analysis of 428 STEMI patients treated with primary PCI.
- Comparison of prehospital DAPT (n=186) versus in-hospital DAPT (n=242) administration.
- Primary endpoint: post-PCI Thrombolysis in Myocardial Infarction (TIMI) flow grade 3; Secondary endpoints: myocardial blush grade (MBG), ST-segment resolution, 30-day MACE, and bleeding.
Main Results:
- Prehospital DAPT showed significantly higher rates of TIMI 3 flow (91.4% vs. 82.2%), complete ST-segment resolution (76.3% vs. 64.5%), and optimal MBG (84.9% vs. 74.4%).
- Time to DAPT was significantly shorter with prehospital administration (8 min vs. 42 min).
- Thirty-day MACE was reduced with prehospital DAPT (5.4% vs. 11.2%) without an increase in major bleeding.
Conclusions:
- Prehospital ticagrelor plus aspirin administration is associated with superior reperfusion and improved short-term outcomes in STEMI patients.
- The findings support the routine implementation of prehospital DAPT within emergency medical services.
- This strategy may optimize early pharmacologic management for STEMI patients globally.
Background:
Early dual antiplatelet therapy (DAPT) improves outcomes in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). Although guidelines recommend prompt P2Y12 inhibitor use, the optimal timing of administration, particularly prehospital versus in-hospital delivery, remains uncertain.
Objective:
This study evaluated whether prehospital ticagrelor loading plus aspirin improves coronary reperfusion and outcomes compared with in-hospital administration in STEMI.
Methods:
We retrospectively analyzed 428 consecutive STEMI patients treated with primary PCI between January 2023 and December 2025. Patients received ticagrelor 180 mg and aspirin 300 mg either prehospital via emergency medical services (n = 186) or after emergency department arrival (n = 242). The primary endpoint was post-PCI Thrombolysis in Myocardial Infarction (TIMI) flow grade 3. Secondary endpoints included myocardial blush grade (MBG), ST-segment resolution, 30-day major adverse cardiovascular events (MACE), and bleeding.
Results:
TIMI 3 flow occurred more frequently with prehospital DAPT than with in-hospital administration (91.4% vs. 82.2%, p = 0.007). Complete ST-segment resolution (≥ 70%) was higher in the prehospital group (76.3% vs. 64.5%, p = 0.008), as was MBG 2-3 (84.9% vs. 74.4%, p = 0.009). Time from first medical contact to DAPT was shorter prehospital (8 vs. 42 min, p < 0.001). Prehospital DAPT independently predicted TIMI 3 flow (OR 2.18, 95% CI 1.24-3.84). Thirty-day MACE was reduced (5.4% vs. 11.2%, p = 0.038), without increased major bleeding.
Conclusion:
Prehospital ticagrelor plus aspirin is associated with superior reperfusion and improved short-term outcomes without excess bleeding, supporting routine implementation within emergency medical services. These findings may inform systems of care and optimize early pharmacologic strategies worldwide in practice.
