The effect of ASA, ticagrelor, and heparin in ST-segment myocardial infarction patients with prolonged transport times to primary percutaneous intervention.

Autor: d'Entremont MA; Division of Cardiology, Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada., Laferrière C; Division of Cardiology, Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada.; Division of Cardiology, Department of Medicine, Université de Montréal, Montréal, Quebec, Canada., Bérubé S; Division of Cardiology, Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada., Couture ÉL; Division of Cardiology, Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada., Lepage S; Division of Cardiology, Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada., Huynh T; Division of Cardiology, Department of Medicine, McGill University Health Center, Montréal, Quebec, Canada., Verreault-Julien L; Division of Cardiology, Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada., Karzon A; Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada., Desgagnés N; Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada., Nguyen M; Division of Cardiology, Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
Jazyk: angličtina
Zdroj: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions [Catheter Cardiovasc Interv] 2021 Mar; Vol. 97 (4), pp. 591-599. Date of Electronic Publication: 2020 Aug 29.
DOI: 10.1002/ccd.29144
Abstrakt: 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.
(© 2020 Wiley Periodicals LLC.)
Databáze: MEDLINE
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