Université Paris 6, ACTION Study Group, Institut de Cardiologie (AP-HP), Centre Hospitalier Universitaire Pitié-Salpêtrière, INSERM UMRS 1166, Paris, France.
Department of Cardiology, Isala Clinics, Zwolle, the Netherlands.
JACC Cardiovasc Interv. 2016 Apr 11;9(7):646-56. doi: 10.1016/j.jcin.2015.12.024. Epub 2016 Mar 5.
The aim of this landmark exploratory analysis, ATLANTIC-H(24), was to evaluate the effects of pre-hospital ticagrelor during the first 24 h after primary percutaneous coronary intervention (PCI) in the ATLANTIC (Administration of Ticagrelor in the cath Lab or in the Ambulance for New ST elevation myocardial infarction to open the Coronary artery) study.
The ATLANTIC trial in patients with ongoing ST-segment elevation myocardial infarction showed that pre-hospital ticagrelor was safe but did not improve pre-PCI coronary reperfusion compared with in-hospital ticagrelor. We hypothesized that the effect of pre-hospital ticagrelor may not have manifested until after PCI due to the rapid transfer time (31 min).
The ATLANTIC-H(24) analysis included 1,629 patients who underwent PCI, evaluating platelet reactivity, Thrombolysis In Myocardial Infarction flow grade 3, ≥ 70% ST-segment elevation resolution, and clinical endpoints over the first 24 h.
Following PCI, largest between-group differences in platelet reactivity occurred at 1 to 6 h; coronary reperfusion rates numerically favored pre-hospital ticagrelor, and the degree of ST-segment elevation resolution was significantly greater in the pre-hospital group (median, 75.0% vs. 71.4%; p = 0.049). At 24 h, the composite ischemic endpoint was lower with pre-hospital ticagrelor (10.4% vs. 13.7%; p = 0.039), as were individual endpoints of definite stent thrombosis (p = 0.0078) and myocardial infarction (p = 0.031). All endpoints except death (1.1% vs. 0.2%; p = 0.048) favored pre-hospital ticagrelor, with no differences in bleeding events.
The effects of pre-hospital ticagrelor became apparent after PCI, with numerical differences in platelet reactivity and immediate post-PCI reperfusion, associated with reductions in ischemic endpoints, over the first 24 h, whereas there was a small excess of mortality. (Administration of Ticagrelor in the cath Lab or in the Ambulance for New ST elevation myocardial infarction to open the Coronary artery [ATLANTIC, NCT01347580]).
本项具有里程碑意义的探索性分析（ATLANTIC-H（24））旨在评估在首次经皮冠状动脉介入治疗（PCI）后 24 小时内给予替格瑞洛的效果，该研究来自 ATLANTIC 试验（在新出现 ST 段抬高心肌梗死患者中在导管室或救护车上给予替格瑞洛以开通冠状动脉）。
在持续 ST 段抬高型心肌梗死患者中进行的 ATLANTIC 试验表明，与院内给予替格瑞洛相比，院前给予替格瑞洛是安全的，但并未改善 PCI 前的冠状动脉再灌注。我们假设由于快速转运时间（31 分钟），替格瑞洛的院前给药效果可能要在 PCI 之后才能显现。
该 ATLANTIC-H（24）分析纳入了 1629 例行 PCI 的患者，评估了血小板反应性、心肌梗死溶栓治疗血流分级 3、≥70%ST 段抬高缓解和首次 24 小时内的临床终点。
PCI 后 1 至 6 小时，组间血小板反应性的最大差异；院前替格瑞洛组的冠状动脉再灌注率有数值优势，且院前组的 ST 段抬高缓解程度显著更大（中位数：75.0% vs. 71.4%；p = 0.049）。24 小时时，复合缺血终点发生率在替格瑞洛院前给药组较低（10.4% vs. 13.7%；p = 0.039），确定的支架血栓形成（p = 0.0078）和心肌梗死（p = 0.031）的单一终点也是如此。除死亡率（1.1% vs. 0.2%；p = 0.048）外，所有终点均有利于替格瑞洛院前给药，且出血事件无差异。
在 PCI 后，替格瑞洛的院前给药效果变得明显，血小板反应性和即刻 PCI 后再灌注存在数值差异，与首次 24 小时内的缺血终点减少相关，而死亡率略有增加。（在新出现 ST 段抬高心肌梗死患者中在导管室或救护车上给予替格瑞洛以开通冠状动脉[ATLANTIC，NCT01347580]）。
