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

Impact of presentation and transfer delays on complete ST-segment resolution before primary percutaneous coronary intervention: insights from the ATLANTIC trial

“…Despite remarkable improvement 4 , the timeliness of reperfusion therapy for STEMI patients transferred for primary PCI is often prolonged, with a significant proportion of transferred patients not achieving a guideline-recommended 5,6 door-to-balloon time of less than 90 minutes 4,7 . It is evident, therefore, that, in the real world, early administration of potent antiplatelet therapy may represent an opportunity for improving pre-PCI myocardial reperfusion 8 . This analysis provides further support for a pre-H ticagrelor strategy in STEMI patients, especially for those who still present with a long transfer time.…”

2019 Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology Guidelines on the Acute Management of ST-Elevation Myocardial Infarction: Focused Update on Regionalization and Reperfusion

“…79 Other studies have shown a potential reduction in ischemic complications and improvement in preprocedural TIMI flow with prehospital P2Y12 administration when the transfer time for PPCI was > 60 minutes. 82,83 Because of the relatively short time difference (30-60 minutes) between the prehospital and in-hospital administration of P2Y12 inhibitors in published studies, 79,81 the potential effect of prehospital dual antiplatelet therapy administration might not have been properly evaluated in patients who required more prolonged prehospital transport times and its use potentially could be of benefit for such patients.…”

The effect of ASA, ticagrelor, and heparin in ST‐segment myocardial infarction patients with prolonged transport times to primary percutaneous intervention

“…To our knowledge, this is the first study combining aspirin, ticagrelor, and UFH in a pre‐PPCI setting 11,12 . In STEMI patients, rapid PPCI has a clear mortality benefit and remains the cornerstone of reperfusion therapy 1 .…”

“…The main criticism was the short 48 min time interval between randomization and angiography and the narrow 31 min difference in administration of ticagrelor between both treatment arms. A subsequent retrospective study demonstrated that a longer time interval between prehospital ticagrelor administration and angiography may improve TIMI flow grade but not STR 11 . Furthermore, a SWEDENHEART registry study concluded that ticagrelor pretreatment in STEMI patients did not improve all‐cause mortality, MI or stent thrombosis at 30 days 12 .…”