PMID- 32860646
OWN - NLM
STAT- MEDLINE
DCOM- 20210924
LR  - 20210924
IS  - 1522-726X (Electronic)
IS  - 1522-1946 (Linking)
VI  - 97
IP  - 4
DP  - 2021 Mar
TI  - The effect of ASA, ticagrelor, and heparin in ST-segment myocardial infarction 
      patients with prolonged transport times to primary percutaneous intervention.
PG  - 591-599
LID - 10.1002/ccd.29144 [doi]
AB  - OBJECTIVES: To investigate the effects of early upstream antithrombotic therapy 
      administration (ATTA) in ST-segment elevation myocardial infarction (STEMI) 
      patients with prolonged transport times to primary percutaneous intervention 
      (PPCI) on major clinical outcomes. BACKGROUND: It remains unclear whether early 
      upstream administration of aspirin, ticagrelor, and unfractionated heparin (UFH) 
      confers additional benefits compared with in-hospital administration. METHODS: 
      Between 2015 and 2018, we performed PPCI in 709 included consecutive STEMI 
      patients. We compared 482 STEMI patients who received aspirin, ticagrelor, and 
      UFH loading in a non-PCI capable spoke hospital before transfer (NPHT) versus 227 
      prehospital triage setting (PTS) STEMI patients who received in-ambulance 
      aspirin, followed by ticagrelor and UFH in the hub catheterization laboratory. 
      The primary outcome was the presence of a pre-PPCI TIMI flow 2-3 in the infarct 
      related artery (IRA). The secondary outcomes included definite acute stent 
      thrombosis and hemorrhagic complications. RESULTS: The median times from 
      ticagrelor and heparin administration to angiography in the NPHT group and the 
      PTS group were 80.5 min (Interquartile Range (IQR) 68.5-94) and 10 min (IQR 5-15) 
      respectively (p < .0001). Using inverse probability of treatment weighting to 
      minimize heterogeneity between groups, we showed significant differences for the 
      primary outcome (44.6 versus 18.5%, p < .0001) and for definite acute stent 
      thrombosis (0.6 versus 2.6%, p = .03), with no difference in the combined 
      in-hospital BARC 2-5 bleeding events (1.9 versus 3.5%, p = .18) in the NPHT 
      versus the PTS group, respectively. CONCLUSION: In this single-center 
      retrospective cohort study, after adjusting for baseline covariates, early 
      upstream ATTA with aspirin, ticagrelor, and UFH was associated with greater 
      pre-PPCI TIMI flow and less definite acute stent thrombosis in STEMI patients, 
      without increased bleeding risk.
CI  - (c) 2020 Wiley Periodicals LLC.
FAU - d'Entremont, Marc-Andre
AU  - d'Entremont MA
AUID- ORCID: 0000-0002-1432-7384
AD  - Division of Cardiology, Department of Medicine, Universite de Sherbrooke, 
      Sherbrooke, Quebec, Canada.
FAU - Laferriere, Chloe
AU  - Laferriere C
AD  - Division of Cardiology, Department of Medicine, Universite de Sherbrooke, 
      Sherbrooke, Quebec, Canada.
AD  - Division of Cardiology, Department of Medicine, Universite de Montreal, Montreal, 
      Quebec, Canada.
FAU - Berube, Simon
AU  - Berube S
AD  - Division of Cardiology, Department of Medicine, Universite de Sherbrooke, 
      Sherbrooke, Quebec, Canada.
FAU - Couture, Etienne L
AU  - Couture EL
AUID- ORCID: 0000-0001-6567-4557
AD  - Division of Cardiology, Department of Medicine, Universite de Sherbrooke, 
      Sherbrooke, Quebec, Canada.
FAU - Lepage, Serge
AU  - Lepage S
AD  - Division of Cardiology, Department of Medicine, Universite de Sherbrooke, 
      Sherbrooke, Quebec, Canada.
FAU - Huynh, Thao
AU  - Huynh T
AD  - Division of Cardiology, Department of Medicine, McGill University Health Center, 
      Montreal, Quebec, Canada.
FAU - Verreault-Julien, Louis
AU  - Verreault-Julien L
AD  - Division of Cardiology, Department of Medicine, Universite de Sherbrooke, 
      Sherbrooke, Quebec, Canada.
FAU - Karzon, Anthony
AU  - Karzon A
AD  - Faculty of Medicine and Health Sciences, Universite de Sherbrooke, Sherbrooke, 
      Quebec, Canada.
FAU - Desgagnes, Noemie
AU  - Desgagnes N
AD  - Faculty of Medicine and Health Sciences, Universite de Sherbrooke, Sherbrooke, 
      Quebec, Canada.
FAU - Nguyen, Michel
AU  - Nguyen M
AD  - Division of Cardiology, Department of Medicine, Universite de Sherbrooke, 
      Sherbrooke, Quebec, Canada.
LA  - eng
GR  - Universite de Sherbrooke/
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20200829
PL  - United States
TA  - Catheter Cardiovasc Interv
JT  - Catheterization and cardiovascular interventions : official journal of the 
      Society for Cardiac Angiography & Interventions
JID - 100884139
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 9005-49-6 (Heparin)
RN  - GLH0314RVC (Ticagrelor)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
CIN - Catheter Cardiovasc Interv. 2021 Mar;97(4):600-601. PMID: 33721415
MH  - Aspirin/adverse effects
MH  - Heparin/adverse effects
MH  - Humans
MH  - *Myocardial Infarction/therapy
MH  - *Percutaneous Coronary Intervention/adverse effects
MH  - Platelet Aggregation Inhibitors/adverse effects
MH  - Retrospective Studies
MH  - *ST Elevation Myocardial Infarction/diagnostic imaging/therapy
MH  - Ticagrelor/adverse effects
MH  - Treatment Outcome
OTO - NOTNLM
OT  - TIMI flow
OT  - acute coronary syndromes
OT  - prehospital
EDAT- 2020/08/30 06:00
MHDA- 2021/09/25 06:00
CRDT- 2020/08/30 06:00
PHST- 2020/07/02 00:00 [received]
PHST- 2020/07/04 00:00 [accepted]
PHST- 2020/08/30 06:00 [pubmed]
PHST- 2021/09/25 06:00 [medline]
PHST- 2020/08/30 06:00 [entrez]
AID - 10.1002/ccd.29144 [doi]
PST - ppublish
SO  - Catheter Cardiovasc Interv. 2021 Mar;97(4):591-599. doi: 10.1002/ccd.29144. Epub 
      2020 Aug 29.