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June 8, 2021Clinical Drug InvestigationOpen Access

Prehospital Adenosine Diphosphate Receptor Blocker Use, Culprit Artery Flow, and Mortality in STEMI: The MADDEC Study

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Why the study?

Although ticagrelor and prasugrel are superior to clopidogrel in long-term ACS management, their acute performance with prehospital loading in primary PCI for STEMI needed evaluation.

Does prehospital loading with newer ADP receptor blockers (ticagrelor or prasugrel) reduce acute mortality and improve culprit artery flow compared to clopidogrel in STEMI patients undergoing primary PCI?

Population

3218 STEMI patients admitted for their first primary PCI

Comparison

Prehospital loading with ticagrelor vs prasugrel vs clopidogrel across consecutive time periods

Design

Retrospective single-center registry study

Follow-up

7 days

Authors

MHMarkus HautamäkiTampere University of Applied SciencesLLLeo‐Pekka LyytikäinenGeneral CardiologyMEMarkku EskolaInterventional Cardiology

Discussion

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Implication

Prehospital ticagrelor/prasugrel use was associated with better flow and lower mortality; leaves open whether randomized trials should test routine prehospital loading.

Structured PICO

Does prehospital loading with newer ADP receptor blockers (ticagrelor or prasugrel) reduce acute mortality and improve culprit artery flow compared to clopidogrel in STEMI patients undergoing primary PCI?

P
Population
3,218 STEMI patients admitted for their first primary percutaneous coronary intervention (PCI), mean age 67.5 years, 70.7% male, single-center (Finland). Key exclusions: patients initially treated by fibrinolysis and those who did not receive any oral ADP blocker.
I
Intervention
Prehospital loading with newer adenosine diphosphate (ADP) receptor blockers (ticagrelor or prasugrel) administered immediately after treatment decision, in addition to aspirin and intravenous low-molecular-weight heparin.
C
Comparator
Prehospital loading with clopidogrel administered immediately after treatment decision, in addition to aspirin and intravenous low-molecular-weight heparin.
O
Outcome
Acute 3- and 7-day all-cause mortality and the presence or absence of moderate or good culprit artery flow (TIMI 2-3) before or after the primary PCI.hard clinical

Prehospital loading with ticagrelor or prasugrel in STEMI patients is associated with improved initial culprit artery flow and reduced acute mortality compared to clopidogrel, particularly when treatment delays are short.

Limitations

  • Unmeasured confounding due to drugs being used mainly during three consecutive periods and changes in cardiac care/population
  • Single-center experience with limited sample size
  • Lack of full data on discharge medication or follow-up data on the use of prescribed medication after discharge
  • Selection bias due to the drastic decrease in patients treated with fibrinolytic therapy during the study period

Cite This Study

Hautamäki et al. (2021) studied this question.

synapsesocial.com/papers/6a724fec75498292b70b74c6https://doi.org/10.1007/s40261-021-01045-2

Topics

STEMI managementPercutaneous coronary intervention
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Prasugrel versus Clopidogrel in Patients with Acute Coronary Syndromes2007 · 6,825 citations
  2. 2Association of different antiplatelet therapies with mortality after primary percutaneous coronary intervention2018 · 66 citations
  3. 3Ticagrelor Versus Clopidogrel in Patients With ST-Elevation Acute Coronary Syndromes Intended for Reperfusion With Primary Percutaneous Coronary Intervention2010 · 509 citations
  4. 4Pre-treatment with P2Y 12 inhibitors in ACS patients: who, when, why, and which agent?2015 · 67 citations
  5. 5Ticagrelor versus Clopidogrel in Patients with Acute Coronary Syndromes2009 · 7,160 citations