Pre-hospital ticagrelor in patients with ST-segment elevationmyocardial infarction with long transport time to primary PCI facility

Background: Pre-hospital ticagrelor, given less than 1 h before coronary intervention (PCI), failed to improve coronary reperfusion in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary PCI. It is unknownwhether a longer interval fromticagrelor administration to primary PCImight reveal any improvement of coronary reperfusion. Methods: Weretrospectively compared 143 patients, pre-treated in spoke centers or ambulancewith ticagrelor at least 1.5 h before PCI (Pre-treatment Group), with 143 propensity score-matched controls treated with ticagrelor in the hub before primary PCI (Control Group) extracted fromRENOVAMI, a large observational Italian registry of more than 1400 STEMI patients enrolled from Jan. 2012 to Oct. 2015 (ClinicalTrials. gov id: NCT01347580). The median time from ticagrelor administration and PCI was 2.08 h (95% CI 1.66-2.84) in the Pre-treatment Group and 0.56 h (95% CI 0.33-0.76) in the Control Group. TIMI flow grade before primary PCI in the infarct related artery was the primary endpoint. Results: The primary endpoint, baseline TIMI flowgrade, was significantly higher in Pre-treatment Group (0.88 +/- 1.14 vs 0.53 +/- 0.86, P = 0.02). However in-hospital mortality, in-hospital stent thrombosis, bleeding rates and other clinical and angiographic outcomes were similar in the two groups. Conclusions: In a real world STEMI network, pre-treatment with ticagrelor in spoke hospitals or in ambulance loading at least 1.5 h before primary PCI is safe and might improve pre-PCI coronary reperfusion, in comparison with ticagrelor administration immediately before PCI. (C) 2016 Elsevier Inc. All rights reserved.