The effect of ASA, ticagrelor, and heparin in ST-segment myocardial infarction patients with prolonged transport times to primary percutaneous intervention.
Catheterization and Cardiovascular Interventions · 2020-08-29 · Observational study
Abstract
OBJECTIVES: To investigate the effects of early upstream antithrombotic therapy administration (ATTA) in ST-segment elevation myocardial infarction (STEMI) patients with prolonged transport times to primary percutaneous intervention (PPCI) on major clinical outcomes. BACKGROUND: It remains unclear whether early upstream administration of aspirin, ticagrelor, and unfractionated heparin (UFH) confers additional benefits compared with in-hospital administration. METHODS: Between 2015 and 2018, we performed PPCI in 709 included consecutive STEMI patients. We compared 482 STEMI patients who received aspirin, ticagrelor, and UFH loading in a non-PCI capable spoke hospital before transfer (NPHT) versus 227 prehospital triage setting (PTS) STEMI patients who received in-ambulance aspirin, followed by ticagrelor and UFH in the hub catheterization laboratory. The primary outcome was the presence of a pre-PPCI TIMI flow 2-3 in the infarct related artery (IRA). The secondary outcomes included definite acute stent thrombosis and hemorrhagic complications. RESULTS: The median times from ticagrelor and heparin administration to angiography in the NPHT group and the PTS group were 80.5 min (Interquartile Range (IQR) 68.5-94) and 10 min (IQR 5-15) respectively (p < .0001). Using inverse probability of treatment weighting to minimize heterogeneity between groups, we showed significant differences for the primary outcome (44.6 versus 18.5%, p < .0001) and for definite acute stent thrombosis (0.6 versus 2.6%, p = .03), with no difference in the combined in-hospital BARC 2-5 bleeding events (1.9 versus 3.5%, p = .18) in the NPHT versus the PTS group, respectively. CONCLUSION: In this single-center retrospective cohort study, after adjusting for baseline covariates, early upstream ATTA with aspirin, ticagrelor, and UFH was associated with greater pre-PPCI TIMI flow and less definite acute stent thrombosis in STEMI patients, without increased bleeding risk.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Antithrombotics & thrombolytics · Acetylsalicylic acid · P2Y12 inhibitors · Heparin · Interfacility & critical care transport
Related articles
- [Treatment of ST segment elevation myocardial infarctions according to the guidelines]. (Herz, 2005)
- Effect of prehospital treatment in STEMI patients undergoing primary PCI. (Catheter Cardiovasc Interv, 2022)
- Current patterns of antithrombotic and revascularisation therapy in patients hospitalised for acute coronary syndromes. Data from the Polish subset of the EPICOR study. (Kardiol Pol, 2017)
- Pre PCI hospital antithrombotic therapy for ST elevation myocardial infarction: striving for consensus. (J Thromb Thrombolysis, 2012)
- Suboptimal anticoagulation with pre-hospital heparin in ST-elevation myocardial infarction. (Thromb Haemost, 2011)
- Facilitated reperfusion with prehospital glycoprotein IIb/IIIa inhibition: predictors of complete ST-segment resolution before primary percutaneous coronary intervention in the On-TIME 2 trial: correlates of reperfusion before primary PCI. (J Electrocardiol, 2011)