TY - JOUR
T1 - Prehospital administration of P2Y12 inhibitors and early coronary reperfusion in primary PCI
T2 - an observational comparative study
AU - De Backer, Ole
AU - Ratcovich, Hanna
AU - Biasco, Luigi
AU - Pedersen, Frants
AU - Helqvist, Steffen
AU - Saunamäki, Kari
AU - Tilsted, Hans-Henrik
AU - Clemmensen, Peter
AU - Olivecrona, Goran
AU - Kelbaek, Henning
AU - Jørgensen, Erik
AU - Engstrøm, Thomas
AU - Holmvang, Lene
PY - 2015/8/31
Y1 - 2015/8/31
N2 - The newer oral P2Y12 inhibitors prasugrel and ticagrelor have been reported to be more potent and faster-acting antiplatelet agents than clopidogrel. This study aimed to investigate whether prehospital loading with prasugrel or ticagrelor improves early coronary reperfusion as compared to prehospital loading with clopidogrel in a real-world ST-elevation myocardial infarction (STEMI) setting. Over a 70-month period, 3497 patients with on-going STEMI of less than 6 hours and without cardiac arrest or cardiogenic shock underwent primary percutaneous coronary intervention (PPCI) at our centre. The primary endpoint of this study was the proportion of patients who did not meet the criteria for TIMI (Thrombolysis In Myocardial Infarction) flow grade 3 in the infarct-related artery at initial angiography before PPCI. Prehospital loading with prasugrel (n = 883) or ticagrelor (n = 491) did not significantly improve coronary reperfusion as compared to prehospital loading with clopidogrel (n = 1,532) - a TIMI-flow 3 at initial angiography was absent in 71.7 %, 69.0 % and 71.5 % of patients, respectively. Major adverse cardiac event (MACE) rates were low at 30 days (3.4 % to 4.0 %) and did not significantly differ between the different P2Y12 inhibitor regimens. In conclusion, this large observational, non-randomised study is the first to show that prehospital loading with the newer P2Y12 inhibitors does not improve early coronary reperfusion as compared to prehospital loading with clopidogrel in a PPCI cohort excluding cardiac arrest and cardiogenic shock.
AB - The newer oral P2Y12 inhibitors prasugrel and ticagrelor have been reported to be more potent and faster-acting antiplatelet agents than clopidogrel. This study aimed to investigate whether prehospital loading with prasugrel or ticagrelor improves early coronary reperfusion as compared to prehospital loading with clopidogrel in a real-world ST-elevation myocardial infarction (STEMI) setting. Over a 70-month period, 3497 patients with on-going STEMI of less than 6 hours and without cardiac arrest or cardiogenic shock underwent primary percutaneous coronary intervention (PPCI) at our centre. The primary endpoint of this study was the proportion of patients who did not meet the criteria for TIMI (Thrombolysis In Myocardial Infarction) flow grade 3 in the infarct-related artery at initial angiography before PPCI. Prehospital loading with prasugrel (n = 883) or ticagrelor (n = 491) did not significantly improve coronary reperfusion as compared to prehospital loading with clopidogrel (n = 1,532) - a TIMI-flow 3 at initial angiography was absent in 71.7 %, 69.0 % and 71.5 % of patients, respectively. Major adverse cardiac event (MACE) rates were low at 30 days (3.4 % to 4.0 %) and did not significantly differ between the different P2Y12 inhibitor regimens. In conclusion, this large observational, non-randomised study is the first to show that prehospital loading with the newer P2Y12 inhibitors does not improve early coronary reperfusion as compared to prehospital loading with clopidogrel in a PPCI cohort excluding cardiac arrest and cardiogenic shock.
KW - Adenosine
KW - Aged
KW - Coronary Angiography
KW - Coronary Circulation
KW - Drug Administration Schedule
KW - Emergency Medical Services
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Myocardial Infarction
KW - Percutaneous Coronary Intervention
KW - Platelet Aggregation Inhibitors
KW - Prasugrel Hydrochloride
KW - Purinergic P2Y Receptor Antagonists
KW - Ticlopidine
KW - Time Factors
KW - Treatment Outcome
U2 - 10.1160/th15-01-0026
DO - 10.1160/th15-01-0026
M3 - Journal article
C2 - 25994355
SN - 0340-6245
VL - 114
SP - 623
EP - 631
JO - Thrombosis et diathesis haemorrhagica
JF - Thrombosis et diathesis haemorrhagica
IS - 3
ER -