Key result
Early upstream administration of aspirin, ticagrelor, and UFH before transfer was associated with greater pre-PPCI TIMI flow 2-3 compared to later administration (44.6% vs 18.5%, p<.0001).
Why the study?
It remained unclear whether early upstream administration of aspirin, ticagrelor, and UFH confers additional benefits compared with in-hospital administration in STEMI patients with prolonged transport times to PPCI.
Does early upstream administration of aspirin, ticagrelor, and unfractionated heparin improve pre-PPCI TIMI flow in STEMI patients with prolonged transport times?
Population
709 consecutive STEMI patients undergoing PPCI
Comparison
Spoke hospital upstream aspirin, ticagrelor, and UFH vs in-ambulance aspirin then hub cath lab ticagrelor and UFH
Design
Single-center retrospective cohort study
Authors
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Early upstream ATTA was associated with better pre-PCI flow; leaves open practice change pending randomized confirmation.
Cohort (n=709)
No
Does early upstream administration of aspirin, ticagrelor, and unfractionated heparin improve pre-PPCI TIMI flow in STEMI patients with prolonged transport times?
Absolute Event Rate: 44.6% vs 18.5%
p-value: p=<.0001
Early upstream administration of aspirin, ticagrelor, and unfractionated heparin at non-PCI capable hospitals improves initial infarct-related artery patency and reduces acute stent thrombosis in STEMI patients without increasing bleeding risk.
d’Entremont et al. (2020) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=709). Early upstream administration of aspirin, ticagrelor, and unfractionated heparin before transfer vs. In-ambulance aspirin followed by ticagrelor and unfractionated heparin in the hub catheterization laboratory was evaluated on Presence of a pre-PPCI TIMI flow 2-3 in the infarct related artery (IRA) (p=<.0001). Early upstream administration of aspirin, ticagrelor, and UFH before transfer was associated with greater pre-PPCI TIMI flow 2-3 compared to later administration (44.6% vs 18.5%, p<.0001).
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