Lupi Alessandro, Schaffer Alon, Lazzero Maurizio, Tessitori Massimo, De Martino Leonardo, Rognoni Andrea, Bongo Angelo S, Porto Italo
2nd Cardiology Division, AOU Maggiore della Carità, Novara, Italy; Cardiology Clinic, Eastern Piedmont University, AOU Maggiore della Carità, Novara, Italy.
Cardiology Clinic, Eastern Piedmont University, AOU Maggiore della Carità, Novara, Italy.
Cardiovasc Revasc Med. 2016 Dec;17(8):528-534. doi: 10.1016/j.carrev.2016.08.005. Epub 2016 Aug 20.
Pre-hospital ticagrelor, given less than 1h before coronary intervention (PCI), failed to improve coronary reperfusion in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary PCI. It is unknown whether a longer interval from ticagrelor administration to primary PCI might reveal any improvement of coronary reperfusion.
We retrospectively compared 143 patients, pre-treated in spoke centers or ambulance with ticagrelor at least 1.5h before PCI (Pre-treatment Group), with 143 propensity score-matched controls treated with ticagrelor in the hub before primary PCI (Control Group) extracted from RENOVAMI, a large observational Italian registry of more than 1400 STEMI patients enrolled from Jan. 2012 to Oct. 2015 (ClinicalTrials.gov id: NCT01347580). The median time from ticagrelor administration and PCI was 2.08h (95% CI 1.66-2.84) in the Pre-treatment Group and 0.56h (95% CI 0.33-0.76) in the Control Group. TIMI flow grade before primary PCI in the infarct related artery was the primary endpoint.
The primary endpoint, baseline TIMI flow grade, was significantly higher in Pre-treatment Group (0.88±1.14 vs 0.53±0.86, P=0.02). However in-hospital mortality, in-hospital stent thrombosis, bleeding rates and other clinical and angiographic outcomes were similar in the two groups.
In a real world STEMI network, pre-treatment with ticagrelor in spoke hospitals or in ambulance loading at least 1.5h before primary PCI is safe and might improve pre-PCI coronary reperfusion, in comparison with ticagrelor administration immediately before PCI.
在冠状动脉介入治疗（PCI）前不到1小时给予院前替格瑞洛，未能改善接受直接PCI的ST段抬高型心肌梗死（STEMI）患者的冠状动脉再灌注情况。从替格瑞洛给药到直接PCI的间隔时间延长是否会显示冠状动脉再灌注有所改善尚不清楚。
我们回顾性比较了143例在PCI前至少1.5小时在基层中心或救护车上接受替格瑞洛预处理的患者（预处理组）与143例倾向评分匹配的对照组，对照组在直接PCI前在中心医院接受替格瑞洛治疗（对照组），这些数据来自RENOVAMI，这是一项大型意大利观察性注册研究，纳入了2012年1月至2015年10月期间超过1400例STEMI患者（ClinicalTrials.gov标识符：NCT01347580）。预处理组从替格瑞洛给药到PCI的中位时间为2.08小时（95%CI 1.66-2.84），对照组为0.56小时（95%CI 0.33-0.76）。梗死相关动脉直接PCI前的TIMI血流分级是主要终点。
主要终点，即基线TIMI血流分级，预处理组显著更高（0.88±1.14对0.53±0.86，P=0.02）。然而，两组的院内死亡率、院内支架血栓形成、出血率以及其他临床和血管造影结果相似。
在真实世界的STEMI网络中，与在PCI前立即给予替格瑞洛相比，在基层医院或救护车上在直接PCI前至少1.5小时给予替格瑞洛预处理是安全的，并且可能改善PCI前的冠状动脉再灌注。
