Key result
Pre-hospital heparin, aspirin, and ticagrelor linked to ~54% less TIMI 0 flow vs aspirin alone.
Why the study?
The appropriate timing to administer antithrombotic therapies in STEMI patients undergoing primary PCI remains uncertain.
Does pre-hospital administration of heparin, aspirin, and ticagrelor improve basal reperfusion and reduce infarct size in STEMI patients undergoing primary PCI?
Observational (n=537)
Does pre-hospital administration of heparin, aspirin, and ticagrelor improve basal reperfusion and reduce infarct size in STEMI patients undergoing primary PCI?
Early pre-hospital administration of heparin, aspirin, and ticagrelor at first medical contact improves initial coronary patency and reduces infarct size in STEMI patients without increasing bleeding risk.
Answers are grounded in this paper and cite their sources.
Associated with better initial patency in STEMI; hypothesis-generating and should not yet change practice.
Aims The appropriate timing to administer antithrombotic therapies in ST-elevation myocardial infarction (STEMI) remains uncertain. This study aims to evaluate the role of antithrombotic therapy administration at first medical contact (FMC) compared to the administration in the Cathlab. Methods and results We conducted a ‘before-after’ observational study enrolling STEMI undergoing primary percutaneous coronary intervention (PCI). Outcomes were evaluated during two successive periods, before (control group: aspirin only at FMC) and after (pre-treated intervention group: heparin, aspirin plus ticagrelor at FMC) the introduction of a new regional pre-treatment protocol. 537 consecutive patients (300 in control vs. 237 in intervention group) were enrolled. The pre-treated compared to no pre-treated population showed better basal reperfusion, expressed as basal thrombolysis in myocardial Infarction (TIMI)-flow (p for trend P < 0.001). Pre-treated population showed lower frequency of TIMI 0 (56.5% vs. 73.7%, OR: 0.46, 95% CI: 0.32–0.67, P < 0.001) and higher frequency of TIMI 2–3 (33.3% vs. 19.7%; OR: 2.0; 95% CI: 1.38–2.00, P < 0.001) and TIMI 3 [14.3% vs. 9.7%, OR: 1.56, 95% CI: (0.92–2.65), P = 0.094]. Pre-treated compared to no pre-treated population showed reduced infarct size expressed as Troponin Peak [20 286 (8726–75027) vs. 48 676 (17229–113900), P = 0.001], and higher left ventricular ejection fraction at discharge [53% (44–59) vs. 50% (44–56), P = 0.027]. In-Hospital BARC ≥2 bleeding were similar (2.1% vs. 2.0%, P = 0.929, in pre-treated vs. no pre-treated population, respectively). Conclusions This study provides support for an early pre-treatment strategy in STEMI patients and confirmed the importance of an efficient organization of STEMI networks which allow initiation of antithrombotic treatment at FMC.
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Fabris et al. (2021) conducted an observational in ST-elevation myocardial infarction (STEMI) (n=537). Heparin, aspirin plus ticagrelor at first medical contact vs. Aspirin only at first medical contact was evaluated on TIMI 0 flow (OR 0.46, 95% CI 0.32-0.67, p=<0.001). Pre-hospital heparin, aspirin, and ticagrelor at first medical contact reduced TIMI 0 flow compared to aspirin alone (56.5% vs. 73.7%; OR 0.46; 95% CI 0.32-0.67; P<0.001).
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