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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EAdministration of ticagrelor in-ambulance resulted in reduced rates of stent thrombosis in patients with STEMI undergoing percutaneous coronary intervention (PCI) compared with patients who received ticagrelor in-hospital; however, the co\u2014primary end points were not achieved. This article presents data from the 30-Day Study to Evaluate Efficacy and Safety of Pre-hospital vs In-hospital Initiation of Ticagrelor Therapy in STEMI Patients Planned for PCI [ATLANTIC; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01347580\u0026amp;atom=%2Fspmdc%2F14%2F27%2F17.2.atom\u0022\u003ENCT01347580\u003C\/a\u003E].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMyocardial Infarction\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMyocardial Infarction\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EAdministration of ticagrelor in-ambulance resulted in reduced rates of stent thrombosis in patients with STEMI undergoing percutaneous coronary intervention (PCI) compared with patients who received ticagrelor in-hospital; however, the co\u2014primary end points were not achieved. Gilles Montalescot, MD, PhD, Centre Hospitalier Universtaire Piti\u00e9-Salp\u00eatri\u00e8re, Paris, France, presented data from the 30-Day Study to Evaluate Efficacy and Safety of Pre-hospital vs In-hospital Initiation of Ticagrelor Therapy in STEMI Patients Planned for PCI [ATLANTIC; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01347580\u0026amp;atom=%2Fspmdc%2F14%2F27%2F17.2.atom\u0022\u003ENCT01347580\u003C\/a\u003E].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EAlthough PCI is a lifesaving procedure for patients with STEMI, a feared potential complication is stent thrombosis. Dual antiplatelet therapy, which includes aspirin plus a P2Y12 antagonist inhibitor such as ticagrelor, is recommended to reduce the risk of stent thrombosis. The purpose of the ATLANTIC trial was to determine if the administration of ticagrelor in-ambulance is more effective than in-hospital administration in patients with STEMI.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EIn the international double-blind trial, 1862 patients with STEMI who were transferred for primary PCI were randomly assigned to receive 180 mg of ticagrelor in-ambulance or in-hospital with matching placebo. After PCI, all patients received ticagrelor (90 mg, BID) for 30 days. The mean time difference of receiving the loading dose of ticagrelor was 31 minutes. The primary end points of the trial were the proportion of patients not achieving \u2265 70% resolution of ST segment elevation prior to PCI or not achieving TIMI flow grade 3 in the suspected artery at the initial angiograph. Additional clinical end points included rates of definite stent thrombosis and major adverse cardiovascular events (MACEs). The primary safety end point was the rate of minor or major bleeding events.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EIn-ambulance administration of ticagrelor resulted in similar rates of lack of \u2265 70% resolution of ST segment elevation (OR, 0.93; 95% CI, 0.69 to 1.25; \u003Cem\u003EP\u003C\/em\u003E = .63), TIMI flow grade 3 (OR, 0.97; 95% CI, 0.75 to 1.25; \u003Cem\u003EP\u003C\/em\u003E = .82), or MACEs (\u003Cem\u003EP\u003C\/em\u003E = .91) compared with patients who received in-hospital ticagrelor at 30 days. However, treatment with ticagrelor in-ambulance resulted in lower rates of definite stent thrombosis up to 24 hours (\u003Cem\u003EP\u003C\/em\u003E = .0008) and 30 days (OR, 0.19; 95% CI, 0.04 to 0.86; \u003Cem\u003EP\u003C\/em\u003E = .0225) compared with in-hospital treatment. Bleeding rates included minor, major, or life-threatening bleeding related to non\u2014coronary artery bypass grafting for up to 30 days. In addition, rates of overall and serious adverse events were similar between both arms in the study.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EProf Montalescot concluded by stating that, in his opinion, the data from the ATLANTIC trial suggested that in-ambulance administration of ticagrelor was safe and reduced the risk of stent thrombosis in patients with STEMI undergoing PCI. The discussant, Paul Wayne Armstrong, MD, Edmonton, Alberta, Canada, stated that the reduction of stent thrombosis but also the failure to achieve the co\u2014primary end points may be due to chance. In particular, the short time difference of 31 minutes between the pre- or in-hospital administration of ticagrelor may have undermined the results of this study. Therefore, Prof Armstrong suggested that the role of ticagrelor administered in-ambulance is yet to be established.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/27\/17.2.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzou4p\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}