No Benefit of Ticagrelor Pretreatment Compared With Treatment During Percutaneous Coronary Intervention in Patients With ST-Segment-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Sasha Koul; J Gustav Smith; Matthias Götberg; Elmir Omerovic; Joakim Alfredsson; Dimitrios Venetsanos; Jonas Persson; Jens Jensen; Bo Lagerqvist; Björn Redfors; Stefan James; David Erlinge

doi:10.1161/CIRCINTERVENTIONS.117.005528

No Benefit of Ticagrelor Pretreatment Compared With Treatment During Percutaneous Coronary Intervention in Patients With ST-Segment-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Circ Cardiovasc Interv. 2018 Mar;11(3):e005528. doi: 10.1161/CIRCINTERVENTIONS.117.005528.

Affiliations

¹ From the Department of Cardiology (S.K., J.G.S., M.G., D.E.) and Department of Clinical Sciences (S.K., J.G.S., M.G., D.E.), Skane University Hospital Lund, Lund University, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (E.O., B.R.); Department of Cardiology (J.A., D.V.) and Department of Medical and Health Sciences (J.A., D.V.), Linköping University, Sweden; Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd University Hospital (J.P.) and Department of Medicine, Capio Saint Göran Hospital (J.J.), Karolinska Institute, Stockholm, Sweden; and Uppsala Clinical Research Institute, Uppsala University, Sweden (B.L., S.J.). sashamkoul@gmail.com.
² From the Department of Cardiology (S.K., J.G.S., M.G., D.E.) and Department of Clinical Sciences (S.K., J.G.S., M.G., D.E.), Skane University Hospital Lund, Lund University, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (E.O., B.R.); Department of Cardiology (J.A., D.V.) and Department of Medical and Health Sciences (J.A., D.V.), Linköping University, Sweden; Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd University Hospital (J.P.) and Department of Medicine, Capio Saint Göran Hospital (J.J.), Karolinska Institute, Stockholm, Sweden; and Uppsala Clinical Research Institute, Uppsala University, Sweden (B.L., S.J.).

PMID: 29870381
DOI: 10.1161/CIRCINTERVENTIONS.117.005528

Abstract

Background: The effects of ticagrelor pretreatment in patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI) is debated. This study investigated the effects of ticagrelor pretreatment on clinical outcomes in this patient group.

Methods and results: Patients with ST-segment-elevation myocardial infarction undergoing primary PCI were included from October 2010 to October 2014 in Sweden. Screening was done using the SWEDEHEART register (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies). A total of 7433 patients were included for analysis with 5438 patients receiving ticagrelor pretreatment and 1995 patients with ticagrelor given only in the catheterization laboratory. The primary end point of the study was 30-day event rates of a composite of all-cause mortality, myocardial infarction (MI), and stent thrombosis. Secondary end points were mortality, MI, or stent thrombosis alone and major in-hospital bleeding. Crude event rates showed no difference in 30-day composite end point (6.2% versus 6.5%; P=0.69), mortality (4.5% versus 4.7%; P=0.86), MI (1.6% versus 1.7%; P=0.72), or stent thrombosis (0.5% versus 0.4%; P=0.80) with ticagrelor pretreatment. Three different statistical models were used to correct for baseline differences. No difference in the composite end point, mortality, MI, or stent thrombosis was seen between the 2 groups after statistical adjustment. No increase in in-hospital major bleeding rate was observed with ticagrelor pretreatment.

Conclusions: Ticagrelor pretreatment versus ticagrelor given in the catheterization laboratory in patients with ST-segment-elevation myocardial infarction undergoing primary PCI did not improve the composite end point of all-cause mortality or MI or stent thrombosis or its individual components at 30 days.

Keywords: ST-elevation myocardial infarction; myocardial infarction; percutaneous coronary intervention; stents; thrombosis.

Publication types

Comparative Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Coronary Thrombosis / etiology
Drug Administration Schedule
Female
Hemorrhage / chemically induced
Humans
Male
Middle Aged
Percutaneous Coronary Intervention* / adverse effects
Percutaneous Coronary Intervention* / mortality
Platelet Aggregation Inhibitors / administration & dosage*
Platelet Aggregation Inhibitors / adverse effects
Recurrence
Registries
Risk Factors
ST Elevation Myocardial Infarction / diagnostic imaging
ST Elevation Myocardial Infarction / mortality
ST Elevation Myocardial Infarction / therapy*
Sweden / epidemiology
Ticagrelor / administration & dosage*
Ticagrelor / adverse effects
Time Factors
Treatment Outcome

Substances

Platelet Aggregation Inhibitors
Ticagrelor