Effect of Pre-Hospital Ticagrelor During the First 24 Hours After Primary PCI in Patients With ST-Segment Elevation Myocardial Infarction. The ATLANTIC-H24 Analysis

Gilles Montalescot, Arnoud W. van 't Hof, Leonardo Bolognese, Warren J. Cantor, Angel Cequier, Mohamed Chettibi, Jean Philippe Collet, Shaun G. Goodman, Christopher J. Hammett, Kurt Huber, Magnus Janzon, Frédéric Lapostolle, Jens Flensted Lassen, Muriel Licour, B. Merkely, Néjoua Salhi, Johanne Silvain, Robert F. Storey, Jurriën M. ten Berg, Anne TsatsarisUwe Zeymer, Eric Vicaut, I. Édes

Research output: Contribution to journalArticle

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Abstract

Objectives: The aim of this landmark exploratory analysis, ATLANTIC-H24, was to evaluate the effects of pre-hospital ticagrelor during the first 24 h after primary percutaneous coronary intervention (PCI) in the ATLANTIC (Administration of Ticagrelor in the cath Lab or in the Ambulance for New ST elevation myocardial infarction to open the Coronary artery study). Background: The ATLANTIC trial in patients with ongoing ST-segment elevation myocardial infarction showed that pre-hospital ticagrelor was safe but did not improve pre-PCI coronary reperfusion compared with in-hospital ticagrelor. We hypothesized that the effect of pre-hospital ticagrelor may not have manifested until after PCI due to the rapid transfer time (31 min). Methods: The ATLANTIC-H24 analysis included 1,629 patients who underwent PCI, evaluating platelet reactivity, Thrombolysis In Myocardial Infarction grade 3 flow, ≥70% ST-segment elevation resolution, and clinical endpoints over the first 24 h. Results: Following PCI, largest between-group differences in platelet reactivity occurred at 1 to 6 h; coronary reperfusion rates numerically favored pre-hospital ticagrelor, and the degree of ST-segment elevation resolution was significantly greater in the pre-hospital group (median, 75.0% vs. 71.4%, p = 0.049). At 24 h, the composite ischemic endpoint was lower with pre-hospital ticagrelor (10.4% vs. 13.7%, p = 0.039), as were individual endpoints of definite stent thrombosis (p = 0.0078) and myocardial infarction (p = 0.031). All endpoints except death (1.1% vs. 0.2%, p = 0.048) favored pre-hospital ticagrelor, with no differences in bleeding events. Conclusions: The effects of pre-hospital ticagrelor became apparent after PCI, with numerical differences in platelet reactivity and immediate post-PCI reperfusion, associated with reductions in ischemic endpoints, over the first 24 h, whereas there was a small excess of mortality. (Administration of Ticagrelor in the cath Lab or in the Ambulance for New ST elevation myocardial infarction to open the Coronary artery [ATLANTIC, NCT01347580]).

Original languageEnglish
JournalJACC: Cardiovascular Interventions
DOIs
Publication statusAccepted/In press - Jul 23 2015

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Percutaneous Coronary Intervention
Myocardial Reperfusion
Ambulances
Blood Platelets
Coronary Vessels
Myocardial Infarction
ST Elevation Myocardial Infarction
Ticagrelor
Stents
Thrombosis
Hemorrhage
Mortality

Keywords

  • Myocardial infarction
  • Platelets
  • Reperfusion
  • Stents
  • Thrombosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Effect of Pre-Hospital Ticagrelor During the First 24 Hours After Primary PCI in Patients With ST-Segment Elevation Myocardial Infarction. The ATLANTIC-H24 Analysis. / Montalescot, Gilles; van 't Hof, Arnoud W.; Bolognese, Leonardo; Cantor, Warren J.; Cequier, Angel; Chettibi, Mohamed; Collet, Jean Philippe; Goodman, Shaun G.; Hammett, Christopher J.; Huber, Kurt; Janzon, Magnus; Lapostolle, Frédéric; Lassen, Jens Flensted; Licour, Muriel; Merkely, B.; Salhi, Néjoua; Silvain, Johanne; Storey, Robert F.; ten Berg, Jurriën M.; Tsatsaris, Anne; Zeymer, Uwe; Vicaut, Eric; Édes, I.

In: JACC: Cardiovascular Interventions, 23.07.2015.

Research output: Contribution to journalArticle

Montalescot, G, van 't Hof, AW, Bolognese, L, Cantor, WJ, Cequier, A, Chettibi, M, Collet, JP, Goodman, SG, Hammett, CJ, Huber, K, Janzon, M, Lapostolle, F, Lassen, JF, Licour, M, Merkely, B, Salhi, N, Silvain, J, Storey, RF, ten Berg, JM, Tsatsaris, A, Zeymer, U, Vicaut, E & Édes, I 2015, 'Effect of Pre-Hospital Ticagrelor During the First 24 Hours After Primary PCI in Patients With ST-Segment Elevation Myocardial Infarction. The ATLANTIC-H24 Analysis', JACC: Cardiovascular Interventions. https://doi.org/10.1016/j.jcin.2015.12.024
Montalescot, Gilles ; van 't Hof, Arnoud W. ; Bolognese, Leonardo ; Cantor, Warren J. ; Cequier, Angel ; Chettibi, Mohamed ; Collet, Jean Philippe ; Goodman, Shaun G. ; Hammett, Christopher J. ; Huber, Kurt ; Janzon, Magnus ; Lapostolle, Frédéric ; Lassen, Jens Flensted ; Licour, Muriel ; Merkely, B. ; Salhi, Néjoua ; Silvain, Johanne ; Storey, Robert F. ; ten Berg, Jurriën M. ; Tsatsaris, Anne ; Zeymer, Uwe ; Vicaut, Eric ; Édes, I. / Effect of Pre-Hospital Ticagrelor During the First 24 Hours After Primary PCI in Patients With ST-Segment Elevation Myocardial Infarction. The ATLANTIC-H24 Analysis. In: JACC: Cardiovascular Interventions. 2015.
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abstract = "Objectives: The aim of this landmark exploratory analysis, ATLANTIC-H24, was to evaluate the effects of pre-hospital ticagrelor during the first 24 h after primary percutaneous coronary intervention (PCI) in the ATLANTIC (Administration of Ticagrelor in the cath Lab or in the Ambulance for New ST elevation myocardial infarction to open the Coronary artery study). Background: The ATLANTIC trial in patients with ongoing ST-segment elevation myocardial infarction showed that pre-hospital ticagrelor was safe but did not improve pre-PCI coronary reperfusion compared with in-hospital ticagrelor. We hypothesized that the effect of pre-hospital ticagrelor may not have manifested until after PCI due to the rapid transfer time (31 min). Methods: The ATLANTIC-H24 analysis included 1,629 patients who underwent PCI, evaluating platelet reactivity, Thrombolysis In Myocardial Infarction grade 3 flow, ≥70{\%} ST-segment elevation resolution, and clinical endpoints over the first 24 h. Results: Following PCI, largest between-group differences in platelet reactivity occurred at 1 to 6 h; coronary reperfusion rates numerically favored pre-hospital ticagrelor, and the degree of ST-segment elevation resolution was significantly greater in the pre-hospital group (median, 75.0{\%} vs. 71.4{\%}, p = 0.049). At 24 h, the composite ischemic endpoint was lower with pre-hospital ticagrelor (10.4{\%} vs. 13.7{\%}, p = 0.039), as were individual endpoints of definite stent thrombosis (p = 0.0078) and myocardial infarction (p = 0.031). All endpoints except death (1.1{\%} vs. 0.2{\%}, p = 0.048) favored pre-hospital ticagrelor, with no differences in bleeding events. Conclusions: The effects of pre-hospital ticagrelor became apparent after PCI, with numerical differences in platelet reactivity and immediate post-PCI reperfusion, associated with reductions in ischemic endpoints, over the first 24 h, whereas there was a small excess of mortality. (Administration of Ticagrelor in the cath Lab or in the Ambulance for New ST elevation myocardial infarction to open the Coronary artery [ATLANTIC, NCT01347580]).",
keywords = "Myocardial infarction, Platelets, Reperfusion, Stents, Thrombosis",
author = "Gilles Montalescot and {van 't Hof}, {Arnoud W.} and Leonardo Bolognese and Cantor, {Warren J.} and Angel Cequier and Mohamed Chettibi and Collet, {Jean Philippe} and Goodman, {Shaun G.} and Hammett, {Christopher J.} and Kurt Huber and Magnus Janzon and Fr{\'e}d{\'e}ric Lapostolle and Lassen, {Jens Flensted} and Muriel Licour and B. Merkely and N{\'e}joua Salhi and Johanne Silvain and Storey, {Robert F.} and {ten Berg}, {Jurri{\"e}n M.} and Anne Tsatsaris and Uwe Zeymer and Eric Vicaut and I. {\'E}des",
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T1 - Effect of Pre-Hospital Ticagrelor During the First 24 Hours After Primary PCI in Patients With ST-Segment Elevation Myocardial Infarction. The ATLANTIC-H24 Analysis

AU - Montalescot, Gilles

AU - van 't Hof, Arnoud W.

AU - Bolognese, Leonardo

AU - Cantor, Warren J.

AU - Cequier, Angel

AU - Chettibi, Mohamed

AU - Collet, Jean Philippe

AU - Goodman, Shaun G.

AU - Hammett, Christopher J.

AU - Huber, Kurt

AU - Janzon, Magnus

AU - Lapostolle, Frédéric

AU - Lassen, Jens Flensted

AU - Licour, Muriel

AU - Merkely, B.

AU - Salhi, Néjoua

AU - Silvain, Johanne

AU - Storey, Robert F.

AU - ten Berg, Jurriën M.

AU - Tsatsaris, Anne

AU - Zeymer, Uwe

AU - Vicaut, Eric

AU - Édes, I.

PY - 2015/7/23

Y1 - 2015/7/23

N2 - Objectives: The aim of this landmark exploratory analysis, ATLANTIC-H24, was to evaluate the effects of pre-hospital ticagrelor during the first 24 h after primary percutaneous coronary intervention (PCI) in the ATLANTIC (Administration of Ticagrelor in the cath Lab or in the Ambulance for New ST elevation myocardial infarction to open the Coronary artery study). Background: The ATLANTIC trial in patients with ongoing ST-segment elevation myocardial infarction showed that pre-hospital ticagrelor was safe but did not improve pre-PCI coronary reperfusion compared with in-hospital ticagrelor. We hypothesized that the effect of pre-hospital ticagrelor may not have manifested until after PCI due to the rapid transfer time (31 min). Methods: The ATLANTIC-H24 analysis included 1,629 patients who underwent PCI, evaluating platelet reactivity, Thrombolysis In Myocardial Infarction grade 3 flow, ≥70% ST-segment elevation resolution, and clinical endpoints over the first 24 h. Results: Following PCI, largest between-group differences in platelet reactivity occurred at 1 to 6 h; coronary reperfusion rates numerically favored pre-hospital ticagrelor, and the degree of ST-segment elevation resolution was significantly greater in the pre-hospital group (median, 75.0% vs. 71.4%, p = 0.049). At 24 h, the composite ischemic endpoint was lower with pre-hospital ticagrelor (10.4% vs. 13.7%, p = 0.039), as were individual endpoints of definite stent thrombosis (p = 0.0078) and myocardial infarction (p = 0.031). All endpoints except death (1.1% vs. 0.2%, p = 0.048) favored pre-hospital ticagrelor, with no differences in bleeding events. Conclusions: The effects of pre-hospital ticagrelor became apparent after PCI, with numerical differences in platelet reactivity and immediate post-PCI reperfusion, associated with reductions in ischemic endpoints, over the first 24 h, whereas there was a small excess of mortality. (Administration of Ticagrelor in the cath Lab or in the Ambulance for New ST elevation myocardial infarction to open the Coronary artery [ATLANTIC, NCT01347580]).

AB - Objectives: The aim of this landmark exploratory analysis, ATLANTIC-H24, was to evaluate the effects of pre-hospital ticagrelor during the first 24 h after primary percutaneous coronary intervention (PCI) in the ATLANTIC (Administration of Ticagrelor in the cath Lab or in the Ambulance for New ST elevation myocardial infarction to open the Coronary artery study). Background: The ATLANTIC trial in patients with ongoing ST-segment elevation myocardial infarction showed that pre-hospital ticagrelor was safe but did not improve pre-PCI coronary reperfusion compared with in-hospital ticagrelor. We hypothesized that the effect of pre-hospital ticagrelor may not have manifested until after PCI due to the rapid transfer time (31 min). Methods: The ATLANTIC-H24 analysis included 1,629 patients who underwent PCI, evaluating platelet reactivity, Thrombolysis In Myocardial Infarction grade 3 flow, ≥70% ST-segment elevation resolution, and clinical endpoints over the first 24 h. Results: Following PCI, largest between-group differences in platelet reactivity occurred at 1 to 6 h; coronary reperfusion rates numerically favored pre-hospital ticagrelor, and the degree of ST-segment elevation resolution was significantly greater in the pre-hospital group (median, 75.0% vs. 71.4%, p = 0.049). At 24 h, the composite ischemic endpoint was lower with pre-hospital ticagrelor (10.4% vs. 13.7%, p = 0.039), as were individual endpoints of definite stent thrombosis (p = 0.0078) and myocardial infarction (p = 0.031). All endpoints except death (1.1% vs. 0.2%, p = 0.048) favored pre-hospital ticagrelor, with no differences in bleeding events. Conclusions: The effects of pre-hospital ticagrelor became apparent after PCI, with numerical differences in platelet reactivity and immediate post-PCI reperfusion, associated with reductions in ischemic endpoints, over the first 24 h, whereas there was a small excess of mortality. (Administration of Ticagrelor in the cath Lab or in the Ambulance for New ST elevation myocardial infarction to open the Coronary artery [ATLANTIC, NCT01347580]).

KW - Myocardial infarction

KW - Platelets

KW - Reperfusion

KW - Stents

KW - Thrombosis

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