Our mission is to become a worldwide reference for education in the field for all professionals involved in the process to disseminate knowledge & skills of Acute Cardiovascular Care.
Our mission is to promote excellence in clinical diagnosis, research, technical development, and education in cardiovascular imaging.
Our mission is to promote excellence in research, practice, education and policy in cardiovascular health, primary and secondary prevention.
Our mission is to reduce the burden of cardiovascular disease through percutaneous cardiovascular interventions.
Improving the quality of life and reducing sudden cardiac death by limiting the impact of heart rhythm disturbances.
Our mission is to improve quality of life and longevity, through better prevention, diagnosis and treatment of heart failure, including the establishment of networks for its management, education and research.
The ESC Working Groups' goal is to stimulate and disseminate scientific knowledge in different fields of cardiology.
The ESC Councils' goal is to share knowledge among medical professionals practicing in specific cardiology domains.
Prof. Gilles Montalescot,
Prof. Paul Wayne Armstrong,
By Gilles Montalescot, FESC (Paris, France)View Discussant report
Read the press release
List of Authors: Gilles Montalescot, on behalf of the ATLANTIC Investigators
Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière, Paris, France
BackgroundThe ATLANTIC study (NCT01347580) was designed to assess the effects of pre-hospital (in-ambulance) versus in-hospital (in-cath lab) administration of the P2Y12 antagonist ticagrelor.MethodsATLANTIC was a 30-day, international, randomized, double-blind, placebo-controlled study in STEMI patients transferred for primary PCI. Immediately after diagnosis of STEMI, patients were randomized to receive either pre- or in-hospital ticagrelor 180 mg with matching placebo. All patients then received ticagrelor 90 mg bd for 30 days. The co-primary endpoints were percentage of patients not reaching ≥70% resolution of ST-segment elevation before PCI or not achieving TIMI flow grade 3 in the culprit artery at initial angiography. Clinical endpoints included rates of major adverse cardiovascular events (MACE) and definite stent thrombosis. The primary safety endpoint was major, life-threatening or minor bleeding (excluding coronary artery bypass graft [CABG]-related bleeding).ResultsBetween 12 Sept 2011 and 3 Oct 2013, 1862 patients from 13 countries were randomised to pre-hospital (n=909) or in-hospital ticagrelor (n=953). Median time difference between the two groups for ticagrelor loading dose was 31 min. There was no difference between the pre- and in-hospital groups in terms of absence of ≥70% ST segment resolution (86.8% vs 87.6%; OR 0.93 [95% CI 0.69, 1.25); p=0.63) or TIMI flow grade 3 (82.6 % vs 83.1%; OR 0.97 [95% CI 0.75, 1.25],; p=0.82), nor in overall rates of MACE at 30 days (4.5% vs 4.4%; p=0.91). A significant reduction in definite stent thrombosis was seen in the pre-hospital group both acutely (≤24 h) (0% vs 0.8%; p=0.0008) and at 30 days (0.2% vs 1.2%; OR 0.19 [95% CI 0.04,0.86]; p=0.0225) (Figure). There were no differences between the groups in rates of non-CABG-related major, life-threatening, or minor bleeding up to 48 h or 30 days, nor in overall or serious adverse event rates.ConclusionsPre-hospital ticagrelor administration a short time before PCI in patients with ongoing STEMI appears to be safe but does not improve pre-PCI coronary reperfusion. It may, however, reduce risk of post-PCI stent thrombosis.
By Paul Wayne Armstrong, FESC (Edmonton, Canada)See Presenter abstract
Open the presentationWatch the Webcast
Hot Line: Myocardial Infarction
Our mission: To reduce the burden of cardiovascular disease
© 2017 European Society of Cardiology. All rights reserved