Key result
Prehospital DAPT linked to ~118% higher odds of post-PCI TIMI 3 flow vs in-hospital administration.
Why the study?
The optimal timing of P2Y12 inhibitor administration, particularly prehospital versus in-hospital delivery, in STEMI patients undergoing primary PCI remains uncertain.
Does prehospital administration of ticagrelor and aspirin improve post-PCI TIMI flow grade 3 in STEMI patients undergoing primary PCI?
Cohort (n=428)
Blinded outcome assessment
No
Does prehospital administration of ticagrelor and aspirin improve post-PCI TIMI flow grade 3 in STEMI patients undergoing primary PCI?
Prehospital administration of ticagrelor and aspirin in STEMI patients significantly improves optimal coronary reperfusion and short-term clinical outcomes without increasing bleeding risk.
Answers are grounded in this paper and cite their sources.
May support prehospital DAPT in STEMI protocols; leaves open confirmation via randomized trials before practice change.
BACKGROUND: Early dual antiplatelet therapy (DAPT) improves outcomes in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). Although guidelines recommend prompt P2Y12 inhibitor use, the optimal timing of administration, particularly prehospital versus in-hospital delivery, remains uncertain. OBJECTIVE: This study evaluated whether prehospital ticagrelor loading plus aspirin improves coronary reperfusion and outcomes compared with in-hospital administration in STEMI. METHODS: We retrospectively analyzed 428 consecutive STEMI patients treated with primary PCI between January 2023 and December 2025. Patients received ticagrelor 180 mg and aspirin 300 mg either prehospital via emergency medical services (n = 186) or after emergency department arrival (n = 242). The primary endpoint was post-PCI Thrombolysis in Myocardial Infarction (TIMI) flow grade 3. Secondary endpoints included myocardial blush grade (MBG), ST-segment resolution, 30-day major adverse cardiovascular events (MACE), and bleeding. RESULTS: TIMI 3 flow occurred more frequently with prehospital DAPT than with in-hospital administration (91.4% vs. 82.2%, p = 0.007). Complete ST-segment resolution (≥ 70%) was higher in the prehospital group (76.3% vs. 64.5%, p = 0.008), as was MBG 2-3 (84.9% vs. 74.4%, p = 0.009). Time from first medical contact to DAPT was shorter prehospital (8 vs. 42 min, p < 0.001). Prehospital DAPT independently predicted TIMI 3 flow (OR 2.18, 95% CI 1.24-3.84). Thirty-day MACE was reduced (5.4% vs. 11.2%, p = 0.038), without increased major bleeding. CONCLUSION: Prehospital ticagrelor plus aspirin is associated with superior reperfusion and improved short-term outcomes without excess bleeding, supporting routine implementation within emergency medical services. These findings may inform systems of care and optimize early pharmacologic strategies worldwide in practice.
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Liu et al. (2026) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=428). Prehospital ticagrelor and aspirin vs. In-hospital ticagrelor and aspirin was evaluated on Post-PCI TIMI flow grade 3 (OR 2.18, 95% CI 1.24-3.84, p=0.007). Prehospital administration of ticagrelor and aspirin increased the odds of achieving post-PCI TIMI flow grade 3 compared to in-hospital administration (OR 2.18, 95% CI 1.24-3.84, p=0.007).
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