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No advantage of ambulance over hospital anti-clot therapy for heart attack patients (SCAAR)



Barcelona, Spain – 29 Aug 2017: In contrast to European and American guidelines that recommend pre-hospital antiplatelet therapy for heart attack patients suffering from ST-elevation myocardial infarction (STEMI), a new study presented at ESC Congress (1) suggests this practice has no advantage over waiting for in-hospital treatment.

“Pre-hospital administration is common practice - despite the lack of definite evidence for its benefit,” said study investigator Dr Elmir Omerovic, PhD, from Sahlgrenska University Hospital, Gothenburg, Sweden.

“But our study – which is the largest cohort study conducted so far –  adds to some previous evidence suggesting there is potential for harm. In fact, inadvertent prehospital administration of these drugs to patients with contraindications to antithrombotic therapy is common. Therefore, considering all current evidence, we think pre-hospital administration should be discouraged.”

The retrospective study used data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) to identify 44,804 STEMI patients undergoing percutaneous coronary intervention (PCI) - a revascularisation procedure - between 2005 and 2016.

Most of the patients were pre-treated with antiplatelet therapy, but 6,964 were not.
 
Comparing pre-treated patients to those not pre-treated, the investigators found no significant benefits of pre-treatment in terms of 30-day mortality (odds ratio 0.91; P=0.36), or other endpoints including measures of arterial blockage, cardiogenic shock, neurological complications, or bleeding complications.
 
The ESC, as well as the American College of Cardiology and American Heart Association recommend pre-hospital antiplatelet treatment, but the current study adds to growing evidence that may tip the pendulum.

The ATLANTIC trial, presented at ESC Congress a few years ago gave the first hint that pre-treatment might offer no advantages, but it was a study with relatively short delays for patients receiving in-hospital treatment, explained Dr. Omerovic.

“Our new data addresses some of the concerns with ATLANTIC and offers stronger evidence that pre-treatment is not necessary,” he said. “We hope the accumulated evidence will be convincing enough to discourage this practice and trigger a change in recommendations.”

ENDS

Notes to editor

Sources of funding: None.

Disclosures: None.


References and notes
(1)The study “An international external validation study of the 2014 European society of cardiology guideline on sudden cardiac death prevention in hypertrophic cardiomyopathy” will be presented during:
·    The Press Conference Hot Line - Late Breaking Registry Results 1 on Tuesday 29 August from 8:00 to 9:00
·    The session Hot Line: Late-Breaking Registry Results 1 on Tuesday 29 August from 11:00 to 12:30 in Barcelona, Main Auditorium.

ESC Press Office
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The press conference timetable is available here.

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About the European Society of Cardiology
The European Society of Cardiology brings together health care professionals from more than 140 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.

About ESC Congress 2017
ESC Congress is the world’s largest and most influential cardiovascular event contributing to global awareness of the latest clinical trials and breakthrough discoveries. ESC Congress 2017 takes place 26 to 30 August at the Fira Gran Via in Barcelona, Spain. The scientific programme is here. More information is available from the ESC Press Office at press@escardio.org.

This press release accompanies both a presentation and an ESC press conference at the ESC Congress 2017. Edited by the ESC from material supplied by the investigators themselves, this press release does not necessarily reflect the opinion of the European Society of Cardiology. The content of the press release has been approved by the presenter.