Ticagrelor More Beneficial to Patients En Route Hospital

For patients with ST-segment elevation myocardial infarction (STEMI), administering ticagrelor in the ambulance safely reduces ischemic events 24 hours following primary percutaneous coronary intervention (PCI).

Professor Gilles Montalescot, head of Cardiology Department, Pitié-Salpétrière Hospital, Paris, France presented at the European Society of Cardiology Congress (ESC) 2015, “We hypothesized that pre-hospital ticagrelor may not have improved coronary reperfusion before PCI because of the average transfer time of 31 minutes and that the effects might occur after PCI. We therefore investigated the impact of pre-hospital ticagrelor in the first 24 hours after PCI in the ATLANTIC-H24 study.”

The ATLANTIC-H24 analyzed 1,629 patients who had all underwent primary PCI in the ATLANTIC trial (study which randomized a total of 1,862 STEMI patients to receive either pre-or in-hospital ticagrelor 180mg dose).

The patients in ATLANTIC H-24 were evaluated for platelet reactivity, coronary reperfusion, and clinical endpoints during the first 24 hours following PCI. And, at 24 hours, the composite ischemic endpoint of death, MI, stent thrombosis, stroke, or urgent revascularization was reduced with pre-hospital ticagrelor along with endpoints of definite stent thrombosis and MI.

Researchers also found the greatest differences in platelet reactivity between groups manifested after PCI. “This suggests that the biological effect of the drug, although more rapid than that of clopidogrel, takes a few hours and the early administration may be beneficial to protect the patient during the vulnerable first hours following coronary stenting.”

“We found differences in platelet reactivity and immediate post-PCI reperfusion that were associated with reductions in ischemic endpoints. This confirms that clinicians should consider giving ticagrelor to patients on their way to the hospital for primary PCI to improve outcomes after the procedure,” Montalescot concluded.