Author + information
- Received July 23, 2015
- Revision received November 30, 2015
- Accepted December 15, 2015
- Published online April 11, 2016.
- Gilles Montalescot, MD, PhDa,∗ (, )
- Arnoud W. van ’t Hof, MD, PhDb,
- Leonardo Bolognese, MDc,
- Warren J. Cantor, MDd,
- Angel Cequier, MD, PhDe,
- Mohamed Chettibi, MD, PhDf,
- Jean-Philippe Collet, MD, PhDa,
- Shaun G. Goodman, MDg,
- Christopher J. Hammett, MB, ChBh,
- Kurt Huber, MDi,
- Magnus Janzon, MD, PhDj,
- Frédéric Lapostolle, MD, PhDk,
- Jens Flensted Lassen, MD, PhDl,
- Muriel Licour, MScm,
- Béla Merkely, MD, PhDn,
- Néjoua Salhi, MDo,
- Johanne Silvain, MD, PhDa,
- Robert F. Storey, MD, DMp,
- Jurriën M. ten Berg, MD, PhDq,
- Anne Tsatsaris, MDm,
- Uwe Zeymer, MDr,
- Eric Vicaut, MD, PhDs,
- Christian W. Hamm, MD, PhDt,
- ATLANTIC Investigators
- aUniversité Paris 6, ACTION Study Group, Institut de Cardiologie (AP-HP), Centre Hospitalier Universitaire Pitié-Salpêtrière, INSERM UMRS 1166, Paris, France
- bDepartment of Cardiology, Isala Clinics, Zwolle, the Netherlands
- cCardiovascular and Neurological Department, Azienda Ospedaliera Arezzo, Arezzo, Italy
- dSouthlake Regional Health Centre, University of Toronto, Newmarket, Ontario, Canada
- eHeart Disease Institute, Hospital Universitario de Bellvitge, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- fCentre Hospito-universitaire Frantz Fanon, Blida, Algeria
- gCanadian Heart Research Centre, Division of Cardiology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
- hDepartment of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- i3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria
- jDepartment of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- kSAMU 93 Hôpital Avicenne, Bobigny, France
- lDepartment of Cardiology B, Aarhus University Hospital, Aarhus N, Denmark
- mAstraZeneca, Rueil Malmaison, France
- nHeart and Vascular Center, Semmelweis University, Budapest, Hungary
- oAstraZeneca, Luton, UK
- pDepartment of Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom
- qDepartment of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, the Netherlands
- rKlinikum Ludwigshafen and Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
- sUnite de Recherche Clinique, Université Paris 7, Hôpital Lariboisière, ACTION Study Group, Paris, France
- tDepartment of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany
- ↵∗Reprint requests and correspondence:
Dr. Gilles Montalescot, ACTION Study Group, Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière, 47 Boulevard de l’Hôpital, 75013 Paris, France.
Objectives The aim of this landmark exploratory analysis, ATLANTIC-H24, was to evaluate the effects of pre-hospital ticagrelor during the first 24 h after primary percutaneous coronary intervention (PCI) in the ATLANTIC (Administration of Ticagrelor in the cath Lab or in the Ambulance for New ST elevation myocardial infarction to open the Coronary artery) study.
Background The ATLANTIC trial in patients with ongoing ST-segment elevation myocardial infarction showed that pre-hospital ticagrelor was safe but did not improve pre-PCI coronary reperfusion compared with in-hospital ticagrelor. We hypothesized that the effect of pre-hospital ticagrelor may not have manifested until after PCI due to the rapid transfer time (31 min).
Methods The ATLANTIC-H24 analysis included 1,629 patients who underwent PCI, evaluating platelet reactivity, Thrombolysis In Myocardial Infarction flow grade 3, ≥70% ST-segment elevation resolution, and clinical endpoints over the first 24 h.
Results Following PCI, largest between-group differences in platelet reactivity occurred at 1 to 6 h; coronary reperfusion rates numerically favored pre-hospital ticagrelor, and the degree of ST-segment elevation resolution was significantly greater in the pre-hospital group (median, 75.0% vs. 71.4%; p = 0.049). At 24 h, the composite ischemic endpoint was lower with pre-hospital ticagrelor (10.4% vs. 13.7%; p = 0.039), as were individual endpoints of definite stent thrombosis (p = 0.0078) and myocardial infarction (p = 0.031). All endpoints except death (1.1% vs. 0.2%; p = 0.048) favored pre-hospital ticagrelor, with no differences in bleeding events.
Conclusions The effects of pre-hospital ticagrelor became apparent after PCI, with numerical differences in platelet reactivity and immediate post-PCI reperfusion, associated with reductions in ischemic endpoints, over the first 24 h, whereas there was a small excess of mortality. (Administration of Ticagrelor in the cath Lab or in the Ambulance for New ST elevation myocardial infarction to open the Coronary artery [ATLANTIC, NCT01347580])
The ATLANTIC study was funded by AstraZeneca. Dr. Montalescot has received research grants to the Institution or consulting/lecture fees from Acuitude, ADIR, Amgen, AstraZeneca, Bayer, Berlin Chimie AG, Boehringer Ingelheim, Bristol-Myers Squibb, Brigham Women's Hospital, Cardiovascular Research Foundation, Celladon, CME resources, Daiichi-Sankyo, Eli-Lilly, Europa, Fédération Française de Cardiologie, Gilead, Hopitaux Universitaires Genève, ICAN, Janssen-Cilag, Lead-Up, Medcon International, Menarini, Medtronic, MSD, Pfizer, Recor, Sanofi, Stentys, The Medicines Company, TIMI Study Group, Universitat Basel, WebMD, and Zoll Medical. Dr. van ‘t Hof has received research and educational grants from Abbott, AstraZeneca, Eli Lilly/Daiichi Sankyo, Merck/Correvio, Medtronic, and The Medicines Company; and speaker fees from Boehringer Ingelheim, Abbott, AstraZeneca, Eli Lilly/Daiichi Sankyo, Merck/Correvio, Medtronic, The Medicines Company, Pfizer, and Sanofi. Dr. Bolognese has received advisory board membership, consulting, and/or lecture fees from Daiichi Sankyo, Eli Lilly, Menarini Ind Farma, Abbott, Medtronic, AstraZeneca, and Iroko Cardio International. Dr. Cantor has received speaker and advisory board fees from AstraZeneca. Dr. Collet has received research grants from Bristol-Myers Squibb, Medtronic, Fédération Française de Cardiologie, and Sociétá Française de Cardiologie; consulting fees from Sanofi, Eli Lilly, and Bristol-Myers Squibb; and lecture fees from Bristol-Myers Squibb, Sanofi, Eli Lilly, and AstraZeneca. Dr. Goodman has received research grants and speaker/consulting honoraria from AstraZeneca, Daiichi Sankyo, Eli Lilly, Sanofi, Bristol-Myers Squibb, Merck, and The Medicines Company. Dr. Hammett has received speaker honoraria from AstraZeneca, Eli Lilly, Boehringer Ingelheim, Bayer, and Medtronic. Dr. Huber has received speaker fees from AstraZeneca, Eli Lilly, and The Medicines Company. Dr. Janzon has received lecture fees from AstraZeneca and Sanofi. Dr. Lapostolle has received research grants or honoraria from AstraZeneca, Bayer, Bristol-Myers Squibb, Boehringer Ingelheim, Daiichi Sankyo, Eli Lilly, Pfizer, and Teleflex. Ms. Licour, Dr. Salhi, and Dr. Tsatsaris are employees of AstraZeneca. Dr. Merkely has received an advisory board membership fees from AstraZeneca. Dr. Silvain has received research grants to the Institution from AstraZeneca, Brahms, Daiichi Sankyo, Eli Lilly, Institute of Cardiometabolism (ICAN), INSERM, Fédération Française de Cardiologie, Fondation de France, Société Française de Cardiologie, and Sanofi; consulting fees from Actelion, AstraZeneca, Daiichi Sankyo, Eli Lilly, and Sanofi; lecture fees from Algorythm, AstraZeneca, and Bristol-Myers Squibb; and travel fees from AstraZeneca, Braun, Bristol-Myers Squibb, and Pfizer. Dr. Storey has received research grants from AstraZeneca and Merck; research support from Accumetrics; honoraria from Accumetrics, AstraZeneca, and Medscape; and consulting fees from Accumetrics, AstraZeneca, Aspen, Correvio, Daiichi Sankyo, PlaqueTec, Regeneron, Roche, The Medicines Company, ThermoFisher Scientific, and Sanofi. Dr. ten Berg has received research grants from Daiichi Sankyo, Eli Lilly, AstraZeneca, Merck, and The Medicines Company. Dr. Zeymer has received research grants from Daiichi Sankyo, Eli Lilly, Novartis, and Sanofi; and honoraria from AstraZeneca, Bayer Healthcare, Boehringer Ingelheim, Daiichi Sankyo, Eli Lilly, Merck, Novartis, Sanofi, and The Medicines Company. Dr. Vicaut has received consulting or lecture fees from Abbott, Bristol-Myers Squibb, Celgene, Daiichi-Sankyo, Eli Lilly, Fresenius, European Cardiovascular Research Center, LFB, Hexacath, Medtronic, Novartis, Pfizer, Sanofi, and Sorin; and grants to his institution (APHP) for clinical trials from AstraZeneca, Boehringer-Ingelheim, and Sanofi. Dr. Hamm has received advisory board and speaker honoraria from AstraZeneca. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 23, 2015.
- Revision received November 30, 2015.
- Accepted December 15, 2015.
- American College of Cardiology Foundation