RSS-Feed abonnieren
DOI: 10.1160/TH14-11-0936
Significant excess of early deaths after prehospital ticagrelor: The ATLANTIC trial challenge
Publikationsverlauf
Received:
12. November 2014
Accepted after major revision:
10. Januar 2015
Publikationsdatum:
22. November 2017 (online)
Summary
The recently published Administration of Ticagrelor in the Cath Lab or in the Ambulance for New ST Elevation Myocardial Infarction to Open the Coronary Artery (ATLANTIC) trial concluded that prehospital administration of ticagrelor in patients with acute STEMI appeared to be safe but did not improve pre-PCI coronary reperfusion. The ATLANTIC data fully support the PLATO Angiographic Substudy denying early benefit of ticagrelor, and correspond well with lack of immediate clinical benefit including the early PCI “death paradox„ in PLATO-USA patients. Finally, there were significantly (p=0.043) more deaths in early ticagrelor ATLANTIC arm (odds ratio 3.18 (1.02–9.90) challenging stent thrombosis reduction. Indeed, ATLANTIC represents an important step for our better understanding of ticagrelor, although the confirmation of the PLATO mortality wonder in an adequately powered PEGASUS (TIMI-54) to be reported in 2015 will be vital for ticagrelor future.
-
References
- 1 Montalescot G, van ’t Hof AW, Lapostolle F. et al. Prehospital ticagrelor in ST-segment elevation myocardial infarction. N Engl J Med 2014; 371: 1016-1027.
- 2 Wallentin L, Becker RC, Budaj A. et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2009; 361: 1045-1057.
- 3 Serebruany VL. Paradoxical excess mortality in the PLATO trial should be independently verified. Thromb Haemost 2011; 105: 752-759.
- 4 Kunadian V, James SK, Wojdyla DM. et al. Angio-graphic Outcomes in the PLATO Trial (Platelet Inhibition and Patient Outcomes. JACC Cardiovasc Interv 2013; 06: 671-683.
- 5 The FDA ticagrelor Secondary Review.. Available for download at http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/CardiovascularandRenalDrugsAdvisoryCommittee/UCM220192.pdf (Assessed October 8th, 2014).
- 6 The FDA Ticagrelor Review of Complete Response.. Available for download at: http://www.acnda/2011/022433Orig1s000TOC.cfm (Assessed October 8th, 2014).
- 7 Supplement to: Montalescot G, van ’t Hof AW, Lapostolle F. et al. Prehospital ticagrelor in ST-segment elevation myocardial infarction. N Engl J Med 2014 http://dx.doi.org/10.1056/NEJMoa1407024
- 8 Bhatt DL, Stone GW, Mahaffey KW. et al. Effect of Platelet Inhibition with Cangrelor during PCI on Ischemic Events. N Engl J Med 2013; 368: 1303-1313.
- 9 Mehta SR, Bassand JP, Chrolavicius S. et al. Dose comparisons of clopidogrel and aspirin in acute coronary syndromes. N Engl J Med 2010; 363: 930-942.
- 10 Bonaca MP, Bhatt DL, Braunwald E. et al. Design and rationale for the Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis in Myocardial Infarction 54 (PEGASUS-TIMI 54) trial. Am Heart J 2014; 167: 437-444.