Impact of presentation and transfer delays on complete ST-segment resolution before primary percutaneous coronary intervention: Insights from the ATLANTIC trial

Enrico Fabris, Arnoud Van't Hof, Christian W. Hamm, Frédéric Lapostolle, Jens Flensted Lassen, Shaun G. Goodman, Jurriën M. Ten Berg, Leonardo Bolognese, Angel Cequier, Mohamed Chettibi, Christopher J. Hammett, Kurt Huber, Magnus Janzon, Béla Merkely, Robert F. Storey, Uwe Zeymer, Warren J. Cantor, Hélène Rousseau, Eric Vicaut, Gilles Montalescot

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Abstract

Aims: The aim of this study was to identify predictors of complete ST-segment resolution (STR) pre-primary percutaneous coronary intervention (PCI) in patients enrolled in the ATLANTIC trial. Methods and results: ECGs recorded at the time of inclusion (pre-hospital [pre-H]-ECG) and in the catheterisation laboratory before angiography (pre-PCI-ECG) were analysed by an independent core laboratory. Complete STR was defined as ≥70%. Complete STR occurred pre-PCI in 12.8% (204/1, 598) of patients and predicted lower 30-day composite MACCE (OR=0.10, 95% CI: 0.002-0.57, p=0.001) and total mortality (OR=0.16, 95% CI: 0.004-0.95, p=0.035). Independent predictors of complete STR included the time from index event to pre-H-ECG (OR=0.94, 95% CI: 0.89-1.00, p=0.035), use of heparins before pre- PCI-ECG (OR=1.75, 95% CI: 1.25-2.45, p=0.001) and time from pre-H-ECG to pre-PCI-ECG (OR=1.09, 95% CI: 1.03-1.16, p=0.005). In the pre-H ticagrelor group, patients with complete STR had a significantly longer delay between pre-H-ECG and pre-PCI-ECG compared to patients without complete STR (median 53 [44-73] vs. 49 [38.5-61] mins, p=0.001); however, this was not observed in the control group (in-hospital ticagrelor) (50 [40-67] vs. 49 [39-61] mins, p=0.258). Conclusions: Short patient delay, early administration of anticoagulant and ticagrelor if a long transfer delay is expected may help to achieve reperfusion prior to PCI. Pre-H treatment may be beneficial in patients with longer transfer delays, allowing the drug to become biologically active. ClinicalTrials.gov Identifier: NCT01347580.

Original languageEnglish
Pages (from-to)69-77
Number of pages9
JournalEuroIntervention
Volume13
Issue number1
DOIs
Publication statusPublished - Jan 1 2017

Keywords

  • Adjunctive pharmacotherapy
  • Clinical research
  • Clinical trials
  • ST-elevation myocardial infarction (STEMI)

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Fabris, E., Van't Hof, A., Hamm, C. W., Lapostolle, F., Lassen, J. F., Goodman, S. G., Ten Berg, J. M., Bolognese, L., Cequier, A., Chettibi, M., Hammett, C. J., Huber, K., Janzon, M., Merkely, B., Storey, R. F., Zeymer, U., Cantor, W. J., Rousseau, H., Vicaut, E., & Montalescot, G. (2017). Impact of presentation and transfer delays on complete ST-segment resolution before primary percutaneous coronary intervention: Insights from the ATLANTIC trial. EuroIntervention, 13(1), 69-77. https://doi.org/10.4244/EIJ-D-16-00965