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Impact of presentation and transfer delays on complete ST-segment resolution before primary percutaneous coronary intervention: insights from the ATLANTIC trial.
Isala Clinics, Zwolle, the Netherlands, University of Trieste, Trieste, Italy.
Isala Clinics, Zwolle, the Netherlands.
Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.
Hôpital Avicenne, Bobigny, France.
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2017 (English)In: EuroIntervention, ISSN 1774-024X, E-ISSN 1969-6213, Vol. 13, no 1, p. 69-77, article id EIJ-D-16-00965Article in journal (Refereed) Published
Abstract [en]

AIMS: The aim of this study was to identify predictors of complete ST-segment resolution (STR) pre-primary percutaneous coronary intervention (PCI) in patients enrolled in the ATLANTIC trial.

METHODS AND RESULTS: ECGs recorded at the time of inclusion (pre-hospital [pre-H]-ECG) and in the catheterisation laboratory before angiography (pre-PCI-ECG) were analysed by an independent core laboratory. Complete STR was defined as ≥70%. Complete STR occurred pre-PCI in 12.8% (204/1,598) of patients and predicted lower 30-day composite MACCE (OR=0.10, 95% CI: 0.002-0.57, p=0.001) and total mortality (OR=0.16, 95% CI: 0.004-0.95, p=0.035). Independent predictors of complete STR included the time from index event to pre-H-ECG (OR=0.94, 95% CI: 0.89-1.00, p=0.035), use of heparins before pre-PCI-ECG (OR=1.75, 95% CI: 1.25-2.45, p=0.001) and time from pre-H-ECG to pre-PCI-ECG (OR=1.09, 95% CI: 1.03-1.16, p=0.005). In the pre-H ticagrelor group, patients with complete STR had a significantly longer delay between pre-H-ECG and pre-PCI-ECG compared to patients without complete STR (median 53 [44-73] vs. 49 [38.5-61] mins, p=0.001); however, this was not observed in the control group (in-hospital ticagrelor) (50 [40-67] vs. 49 [39-61] mins, p=0.258).

CONCLUSIONS: Short patient delay, early administration of anticoagulant and ticagrelor if a long transfer delay is expected may help to achieve reperfusion prior to PCI. Pre-H treatment may be beneficial in patients with longer transfer delays, allowing the drug to become biologically active.

Place, publisher, year, edition, pages
2017. Vol. 13, no 1, p. 69-77, article id EIJ-D-16-00965
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:liu:diva-139101DOI: 10.4244/EIJ-D-16-00965ISI: 000405055700010PubMedID: 28134127OAI: oai:DiVA.org:liu-139101DiVA, id: diva2:1118650
Note

Funding agencies: AstraZeneca

Available from: 2017-07-01 Created: 2017-07-01 Last updated: 2017-08-09Bibliographically approved

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Janzon, Magnus
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Division of Cardiovascular MedicineFaculty of Medicine and Health SciencesDepartment of Cardiology in Linköping
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