Prehospital administration of P2Y12 inhibitors and early coronary reperfusion in primary PCI: an observational comparative study

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 -