Prehospital Ticagrelor in ST-Segment Elevation Myocardial Infarction
Prehospital Ticagrelor in ST-Segment Elevation Myocardial Infarction
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DOI：
10.1056/nejmoa1407024
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发表时间：
2014-09-11
影响因子：
158.5
通讯作者：
Hamm, Christian W.
中科院分区：
文献类型：
--
作者：
Montalescot, Gilles;van 't Hof, Arnoud W.;Hamm, Christian W.
背景：直接作用的血小板P2Y(12)受体拮抗剂替卡格雷入院治疗ST段抬高型心肌梗死(STEMI)可降低主要心血管事件的发生率。院前应用替卡格雷是否能改善冠状动脉再通以及临床结果尚不清楚。方法：我们进行了一项国际性、多中心、随机、双盲研究，对1862例持续STEMI持续时间小于6小时的患者进行院前(在救护车上)和院内(在导尿室)使用替卡格雷的治疗进行比较。主要终点是在经皮冠状动脉介入治疗(PCI)前ST段抬高未达到70%或更高的患者的比例，以及首次冠状动脉造影术时梗死相关动脉3级心肌梗死血流未溶栓的患者的比例。次要终点包括30天主要不良心血管事件和明确支架血栓的发生率。结果从随机到血管造影的中位时间为48分钟，两种治疗策略之间的中位时间差为31分钟。院前组和院内组的两个同室终点没有显著差异。分别有42.5%和47.5%的患者报告在经皮冠状动脉介入治疗(次要终点)后ST段抬高分辨率达70%或以上。两个研究组的主要心血管不良事件发生率没有显著差异。院前组的明确支架血栓发生率低于院内组(前24小时为0%，院内组为0.8%；30天后为0.2%，30天为1.2%)。无论使用何种出血定义，两组的主要出血事件发生率都很低且基本相同。结论院前给药治疗急性STEMI患者似乎是安全的，但不能改善冠状动脉介入治疗前的再灌注。
BACKGROUNDThe direct-acting platelet P2Y(12) receptor antagonist ticagrelor can reduce the incidence of major adverse cardiovascular events when administered at hospital admission to patients with ST-segment elevation myocardial infarction (STEMI). Whether prehospital administration of ticagrelor can improve coronary reperfusion and the clinical outcome is unknown.METHODSWe conducted an international, multicenter, randomized, double-blind study involving 1862 patients with ongoing STEMI of less than 6 hours' duration, comparing prehospital (in the ambulance) versus in-hospital (in the catheterization laboratory) treatment with ticagrelor. The coprimary end points were the proportion of patients who did not have a 70% or greater resolution of ST-segment elevation before percutaneous coronary intervention (PCI) and the proportion of patients who did not have Thrombolysis in Myocardial Infarction flow grade 3 in the infarct-related artery at initial angiography. Secondary end points included the rates of major adverse cardiovascular events and definite stent thrombosis at 30 days.RESULTSThe median time from randomization to angiography was 48 minutes, and the median time difference between the two treatment strategies was 31 minutes. The two coprimary end points did not differ significantly between the prehospital and in-hospital groups. The absence of ST-segment elevation resolution of 70% or greater after PCI (a secondary end point) was reported for 42.5% and 47.5% of the patients, respectively. The rates of major adverse cardiovascular events did not differ significantly between the two study groups. The rates of definite stent thrombosis were lower in the prehospital group than in the in-hospital group (0% vs. 0.8% in the first 24 hours; 0.2% vs. 1.2% at 30 days). Rates of major bleeding events were low and virtually identical in the two groups, regardless of the bleeding definition used.CONCLUSIONSPrehospital administration of ticagrelor in patients with acute STEMI appeared to be safe but did not improve pre-PCI coronary reperfusion.