法国 ATLANTIC 人群中 ST 段抬高型心肌梗死的院前替格瑞洛治疗。

Pre-hospital ticagrelor in ST-segment elevation myocardial infarction in the French ATLANTIC population.

机构信息

Department of Cardiology, CHU Caremeau, Université de Montpellier, Nîmes, France.

SAMU 93, Hôpital Avicenne, Bobigny, France.

出版信息

Int J Cardiol. 2017 Oct 1;244:49-53. doi: 10.1016/j.ijcard.2017.06.009. Epub 2017 Jun 9.

DOI:10.1016/j.ijcard.2017.06.009

PMID:28622941

Abstract

BACKGROUND

ATLANTIC was a randomized study comparing pre- and in-hospital treatment with a ticagrelor loading dose (LD) in ongoing ST-segment elevation myocardial infarction (STEMI). We sought to compare patient characteristics and clinical outcomes in France with other countries participating in ATLANTIC.

METHODS

The population comprised 1862 patients, 660 (35.4%) from France and 1202 from 12 other countries. The main endpoints were reperfusion (≥70% ST-segment elevation resolution) and TIMI flow grade 3 before (co-primary endpoints) and after percutaneous coronary intervention (PCI). Other endpoints included a composite ischaemic endpoint (death/myocardial infarction/stroke/urgent revascularization/definite stent thrombosis) and bleeding events at 30days.

RESULTS

In France, median times from first LD to angiography and between first and second LDs were 49 and 35min, respectively, and were similar to other countries. French patients were younger (mean 58.7 vs 61.9years, p<0.0001) and characterized by a higher rate of radial access (89.9% vs 54.8%, p<0.0001), more frequent use of pre-hospital glycoprotein (GP) IIb/IIIa inhibitors (14.1% vs 3.1%, p<0.0001) and intravenous enoxaparin (57.3% vs 10.1%, p<0.0001). In France, as in other countries, the co-primary endpoints did not differ between the two randomization groups. The composite ischaemic endpoint was numerically lower in France (3.3% vs 5.1%, p=0.07), with a lower mortality (1.4% vs 3.3%, p=0.01). PLATO major bleeding was numerically less frequent in France (1.8% vs 3.2%, p=0.07).

CONCLUSIONS

The French population appears to have better outcomes than the rest of the study population, and seems related to differences in demographics and management characteristics.

TRIAL REGISTRY

ClinicalTrials.gov (NCT01347580).

摘要

背景

ATLANTIC 是一项随机研究，比较了在持续 ST 段抬高型心肌梗死（STEMI）患者中进行预治疗和住院期间使用替格瑞洛负荷剂量（LD）的效果。我们旨在比较法国与参与 ATLANTIC 研究的其他国家/地区的患者特征和临床结局。

方法

该研究纳入了 1862 例患者，其中 660 例（35.4%）来自法国，1202 例来自其他 12 个国家/地区。主要终点为再灌注（≥70% ST 段抬高缓解）和经皮冠状动脉介入治疗（PCI）前（主要共同终点）和后 TIMI 血流 3 级。其他终点包括复合缺血终点（死亡/心肌梗死/卒中和紧急血运重建/确定支架血栓形成）和 30 天内出血事件。

结果

在法国，从首次 LD 到血管造影和首次 LD 与第二次 LD 之间的中位时间分别为 49 分钟和 35 分钟，与其他国家相似。法国患者年龄较小（平均年龄 58.7 岁 vs 61.9 岁，p<0.0001），桡动脉入路比例较高（89.9% vs 54.8%，p<0.0001），更频繁地使用预院外糖蛋白（GP）IIb/IIIa 抑制剂（14.1% vs 3.1%，p<0.0001）和静脉注射依诺肝素（57.3% vs 10.1%，p<0.0001）。与其他国家/地区一样，法国的主要共同终点在两组随机分组之间没有差异。复合缺血终点在法国较低（3.3% vs 5.1%，p=0.07），死亡率较低（1.4% vs 3.3%，p=0.01）。PLATO 大出血在法国也较少见（1.8% vs 3.2%，p=0.07）。