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No benefit of ticagrelor pretreatment compared with treatment during percutaneous coronary intervention in patients with ST-segment⇓elevation myocardial infarction undergoing primary percutaneous coronary intervention

Koul, Sasha LU ; Gustav Smith, J. LU ; Götberg, Matthias LU ; Omerovic, Elmir; Alfredsson, Joakim; Venetsanos, Dimitrios; Persson, Jonas; Jensen, Jens; Lagerqvist, Bo and Redfors, Björn, et al. (2018) In Circulation: Cardiovascular Interventions 11(3).
Abstract

Background—The effects of ticagrelor pretreatment in patients with ST-segment–elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI) is debated. This study investigated the effects of ticagrelor pretreatment on clinical outcomes in this patient group. Methods and Results—Patients with ST-segment–elevation myocardial infarction undergoing primary PCI were included from October 2010 to October 2014 in Sweden. Screening was done using the SWEDEHEART register (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies). A total of 7433 patients were included for analysis with 5438 patients receiving ticagrelor pretreatment and... (More)

Background—The effects of ticagrelor pretreatment in patients with ST-segment–elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI) is debated. This study investigated the effects of ticagrelor pretreatment on clinical outcomes in this patient group. Methods and Results—Patients with ST-segment–elevation myocardial infarction undergoing primary PCI were included from October 2010 to October 2014 in Sweden. Screening was done using the SWEDEHEART register (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies). A total of 7433 patients were included for analysis with 5438 patients receiving ticagrelor pretreatment and 1995 patients with ticagrelor given only in the catheterization laboratory. The primary end point of the study was 30-day event rates of a composite of all-cause mortality, myocardial infarction (MI), and stent thrombosis. Secondary end points were mortality, MI, or stent thrombosis alone and major in-hospital bleeding. Crude event rates showed no difference in 30-day composite end point (6.2% versus 6.5%; P=0.69), mortality (4.5% versus 4.7%; P=0.86), MI (1.6% versus 1.7%; P=0.72), or stent thrombosis (0.5% versus 0.4%; P=0.80) with ticagrelor pretreatment. Three different statistical models were used to correct for baseline differences. No difference in the composite end point, mortality, MI, or stent thrombosis was seen between the 2 groups after statistical adjustment. No increase in in-hospital major bleeding rate was observed with ticagrelor pretreatment. Conclusions—Ticagrelor pretreatment versus ticagrelor given in the catheterization laboratory in patients with ST-segment–elevation myocardial infarction undergoing primary PCI did not improve the composite end point of all-cause mortality or MI or stent thrombosis or its individual components at 30 days.

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published
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keywords
Myocardial infarction, Percutaneous coronary intervention, ST-elevation myocardial infarction, Stents, Thrombosis
in
Circulation: Cardiovascular Interventions
volume
11
issue
3
publisher
American Heart Association
external identifiers
  • scopus:85053432510
ISSN
1941-7640
DOI
10.1161/CIRCINTERVENTIONS.117.005528
language
English
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yes
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8bb1abe6-436f-4103-b63f-accee5dc19f2
date added to LUP
2018-10-19 12:39:56
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2019-08-14 04:25:23
@article{8bb1abe6-436f-4103-b63f-accee5dc19f2,
  abstract     = {<p>Background—The effects of ticagrelor pretreatment in patients with ST-segment–elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI) is debated. This study investigated the effects of ticagrelor pretreatment on clinical outcomes in this patient group. Methods and Results—Patients with ST-segment–elevation myocardial infarction undergoing primary PCI were included from October 2010 to October 2014 in Sweden. Screening was done using the SWEDEHEART register (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies). A total of 7433 patients were included for analysis with 5438 patients receiving ticagrelor pretreatment and 1995 patients with ticagrelor given only in the catheterization laboratory. The primary end point of the study was 30-day event rates of a composite of all-cause mortality, myocardial infarction (MI), and stent thrombosis. Secondary end points were mortality, MI, or stent thrombosis alone and major in-hospital bleeding. Crude event rates showed no difference in 30-day composite end point (6.2% versus 6.5%; P=0.69), mortality (4.5% versus 4.7%; P=0.86), MI (1.6% versus 1.7%; P=0.72), or stent thrombosis (0.5% versus 0.4%; P=0.80) with ticagrelor pretreatment. Three different statistical models were used to correct for baseline differences. No difference in the composite end point, mortality, MI, or stent thrombosis was seen between the 2 groups after statistical adjustment. No increase in in-hospital major bleeding rate was observed with ticagrelor pretreatment. Conclusions—Ticagrelor pretreatment versus ticagrelor given in the catheterization laboratory in patients with ST-segment–elevation myocardial infarction undergoing primary PCI did not improve the composite end point of all-cause mortality or MI or stent thrombosis or its individual components at 30 days.</p>},
  articleno    = {e005528},
  author       = {Koul, Sasha and Gustav Smith, J. and Götberg, Matthias and Omerovic, Elmir and Alfredsson, Joakim and Venetsanos, Dimitrios and Persson, Jonas and Jensen, Jens and Lagerqvist, Bo and Redfors, Björn and James, Stefan and Erlinge, David},
  issn         = {1941-7640},
  keyword      = {Myocardial infarction,Percutaneous coronary intervention,ST-elevation myocardial infarction,Stents,Thrombosis},
  language     = {eng},
  number       = {3},
  publisher    = {American Heart Association},
  series       = {Circulation: Cardiovascular Interventions},
  title        = {No benefit of ticagrelor pretreatment compared with treatment during percutaneous coronary intervention in patients with ST-segment⇓elevation myocardial infarction undergoing primary percutaneous coronary intervention},
  url          = {http://dx.doi.org/10.1161/CIRCINTERVENTIONS.117.005528},
  volume       = {11},
  year         = {2018},
}