PMID- 29421001
OWN - NLM
STAT- MEDLINE
DCOM- 20190130
LR  - 20190130
IS  - 1097-6744 (Electronic)
IS  - 0002-8703 (Linking)
VI  - 196
DP  - 2018 Feb
TI  - Thrombus aspiration and prehospital ticagrelor administration in ST-elevation 
      myocardial infarction: Findings from the ATLANTIC trial.
PG  - 1-8
LID - S0002-8703(17)30301-0 [pii]
LID - 10.1016/j.ahj.2017.09.018 [doi]
AB  - BACKGROUND: The potential interactions between prehospital (pre-H) ticagrelor 
      administration and thrombus aspiration (TA) in patients with ST-elevation 
      myocardial infarction (STEMI) treated with primary percutaneous coronary 
      intervention (PCI) have never been studied. Therefore, we evaluated the potential 
      benefit of TA and pre-H ticagrelor treatment in patients enrolled in the ATLANTIC 
      trial (NCT01347580). METHODS: This analysis included 1,630 patients who underwent 
      primary PCI. Multivariate analysis was used to explore the potential association 
      of TA and pre-H treatment to clinical outcomes. Potential interactions between TA 
      and pre-H ticagrelor were also explored. RESULTS: A total of 941 (57.7%) patients 
      underwent TA. In adjusted multivariate logistic model, pre-H ticagrelor treatment 
      was significantly associated with less frequent new MI or definite stent 
      *thrombosis (ST) (odds ratio [OR] 0.43, 95% CI 0.20-0.92, P=.031), or definite ST 
      (OR 0.26, 95% CI 0.07-0.91, P=.036) at 30 days. Patients treated with TA had 
      higher frequency of Thrombolysis in Myocardial Infarction (TIMI) flow 0-1 
      compared with no-TA group (80.7% vs 51.9%, P<.0001). TA when also adjusted for 
      TIMI flow 0-1 showed significant association only for higher bailout use of 
      glycoprotein IIb/IIIa inhibitors (OR 1.72, 95% CI 1.18-2.50, P=.004) and more 
      frequent 30-day TIMI major bleeding (OR 2.92, 95% CI 1.10-7.76, P=.032). No 
      significant interactions between TA and pre-H ticagrelor were present for the 
      explored end points. CONCLUSIONS: TA when left to physicians' discretion was used 
      in high-risk patients, was associated with bailout use of glycoprotein IIb/IIIa 
      inhibitors and TIMI major bleeding, and had no impact on 30-day clinical 
      outcomes. Conversely, pre-H ticagrelor treatment predicted lower 30-day rates of 
      ST or new MI without interaction with TA.
CI  - Copyright (c) 2017 The Authors. Published by Elsevier Inc. All rights reserved.
FAU - Kilic, Sinem
AU  - Kilic S
AD  - Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands.
FAU - Fabris, Enrico
AU  - Fabris E
AD  - Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands.
FAU - Van't Hof, Arnoud W J
AU  - Van't Hof AWJ
AD  - Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands; Department 
      of Interventional Cardiology, Maastricht University Medical Centre+, Maastricht, 
      the Netherlands. Electronic address: v.r.c.derks@isala.nl.
FAU - Hamm, Christian W
AU  - Hamm CW
AD  - Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany.
FAU - Lapostolle, Frederic
AU  - Lapostolle F
AD  - Service d'Aide Medicale Urgente 93, Hopital Avicenne, Bobigny, France.
FAU - Lassen, Jens Flensted
AU  - Lassen JF
AD  - Department of Cardiology, Aarhus University Hospital, Skejby, Denmark.
FAU - Tsatsaris, Anne
AU  - Tsatsaris A
AD  - AstraZeneca, La Defense, France.
FAU - Diallo, Abdourahmane
AU  - Diallo A
AD  - Unite de Recherche Clinique Lariboisiere, St Louis Hopital Fernand Widal, ACTION 
      study group, Assistance Publique Hopitaux de Paris Universite Paris-Diderot, 
      Paris, France.
FAU - Vicaut, Eric
AU  - Vicaut E
AD  - Sorbonne Universite Paris VI, ACTION Study Group, Pitie-Salpetriere Hospital, 
      INSERM Unite Mixte de Recherche Scientifique, 1166, Paris, France.
FAU - Montalescot, Gilles
AU  - Montalescot G
AD  - Sorbonne Universite Paris VI, ACTION Study Group, Pitie-Salpetriere Hospital, 
      INSERM Unite Mixte de Recherche Scientifique, 1166, Paris, France.
CN  - ATLANTIC Investigators
LA  - eng
SI  - ClinicalTrials.gov/NCT01347580
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20171003
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
RN  - GLH0314RVC (Ticagrelor)
SB  - IM
MH  - Age Factors
MH  - Aged
MH  - Combined Modality Therapy
MH  - Coronary Angiography/methods
MH  - Double-Blind Method
MH  - Emergency Medical Services/*methods
MH  - Female
MH  - Humans
MH  - Internationality
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Percutaneous Coronary Intervention/*methods
MH  - Predictive Value of Tests
MH  - Prognosis
MH  - Risk Assessment
MH  - ST Elevation Myocardial Infarction/*diagnostic imaging/mortality/*therapy
MH  - Sex Factors
MH  - Survival Rate
MH  - Ticagrelor/*therapeutic use
MH  - Treatment Outcome
EDAT- 2018/02/09 06:00
MHDA- 2019/01/31 06:00
CRDT- 2018/02/09 06:00
PHST- 2017/06/12 00:00 [received]
PHST- 2017/09/26 00:00 [accepted]
PHST- 2018/02/09 06:00 [entrez]
PHST- 2018/02/09 06:00 [pubmed]
PHST- 2019/01/31 06:00 [medline]
AID - S0002-8703(17)30301-0 [pii]
AID - 10.1016/j.ahj.2017.09.018 [doi]
PST - ppublish
SO  - Am Heart J. 2018 Feb;196:1-8. doi: 10.1016/j.ahj.2017.09.018. Epub 2017 Oct 3.