Enrico Fabris1,2, Arnoud van 't Hof1,3,4, Christian W Hamm5, Frédéric Lapostolle6, Jens F Lassen7, Shaun G Goodman8, Jurriën M Ten Berg9, Leonardo Bolognese10, Angel Cequier11, Mohamed Chettibi12, Christopher J Hammett13, Kurt Huber14,15, Magnus Janzon16,17, Béla Merkely18, Robert F Storey19, Uwe Zeymer20, Warren J Cantor21, Anne Tsatsaris22, Mathieu Kerneis23, Abdourahmane Diallo24, Eric Vicaut24, Gilles Montalescot23. 1. 1 Cardiology Department, Isala Heart Center, the Netherlands. 2. 2 Cardiovascular Department, University of Trieste, Italy. 3. 3 Department of Cardiology, Maastricht University Medical Center, the Netherlands. 4. 4 Department of Cardiology, Zuyderland Hospital, the Netherlands. 5. 5 Kerckhoff Heart and Thorax Center, Germany. 6. 6 SAMU 93, Hôpital Avicenne, France. 7. 7 Department of Cardiology B, Aarhus University Hospital, Denmark. 8. 8 Canadian Heart Research Centre, University of Toronto, Canada. 9. 9 Department of Cardiology, St Antonius Hospital Nieuwegein, the Netherlands. 10. 10 Cardiovascular and Neurological Department, Azienda Ospedaliera Arezzo, Italy. 11. 11 Heart Disease Institute, University of Barcelona, Spain. 12. 12 Centre Hospito-universitaire Frantz Fanon, Algeria. 13. 13 Department of Cardiology, Royal Brisbane and Women's Hospital, Australia. 14. 14 Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Austria. 15. 15 Sigmund Freud Private University, Austria. 16. 16 Department of Cardiology, Linköping University, Sweden. 17. 17 Department of Medical and Health Sciences, Linköping University, Sweden. 18. 18 Heart and Vascular Center, Semmelweis University, Hungary. 19. 19 Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, UK. 20. 20 Klinikum Ludwigshafen and Institut für Herzinfarktforschung, Germany. 21. 21 Southlake Regional Health Centre, University of Toronto, Canada. 22. 22 AstraZeneca, UK. 23. 23 ACTION Study Group, Sorbonne Université Paris 6, France. 24. 24 ACTION Study Group, Hospital Lariboisiere, France.
Abstract
BACKGROUND: In the ATLANTIC (Administration of Ticagrelor in the catheterization laboratory or in the Ambulance for New ST elevation myocardial Infarction to open the Coronary artery) trial the early use of aspirin, anticoagulation, and ticagrelor coupled with very short medical contact-to-balloon times represent good indicators of optimal treatment of ST-elevation myocardial infarction and an ideal setting to explore which factors may influence coronary reperfusion beyond a well-established pre-hospital system. METHODS: This study sought to evaluate predictors of complete ST-segment resolution after percutaneous coronary intervention in ST-elevation myocardial infarction patients enrolled in the ATLANTIC trial. ST-segment analysis was performed on electrocardiograms recorded at the time of inclusion (pre-hospital electrocardiogram), and one hour after percutaneous coronary intervention (post-percutaneous coronary intervention electrocardiogram) by an independent core laboratory. Complete ST-segment resolution was defined as ≥70% ST-segment resolution. RESULTS: Complete ST-segment resolution occurred post-percutaneous coronary intervention in 54.9% ( n=800/1456) of patients and predicted lower 30-day composite major adverse cardiovascular and cerebrovascular events (odds ratio 0.35, 95% confidence interval 0.19-0.65; p<0.01), definite stent thrombosis (odds ratio 0.18, 95% confidence interval 0.02-0.88; p=0.03), and total mortality (odds ratio 0.43, 95% confidence interval 0.19-0.97; p=0.04). In multivariate analysis, independent negative predictors of complete ST-segment resolution were the time from symptoms to pre-hospital electrocardiogram (odds ratio 0.91, 95% confidence interval 0.85-0.98; p<0.01) and diabetes mellitus (odds ratio 0.6, 95% confidence interval 0.44-0.83; p<0.01); pre-hospital ticagrelor treatment showed a favorable trend for complete ST-segment resolution (odds ratio 1.22, 95% confidence interval 0.99-1.51; p=0.06). CONCLUSIONS: This study confirmed that post-percutaneous coronary intervention complete ST-segment resolution is a valid surrogate marker for cardiovascular clinical outcomes. In the current era of ST-elevation myocardial infarction reperfusion, patients' delay and diabetes mellitus are independent predictors of poor reperfusion and need specific attention in the future.
BACKGROUND: In the ATLANTIC (Administration of Ticagrelor in the catheterization laboratory or in the Ambulance for New ST elevation myocardial Infarction to open the Coronary artery) trial the early use of aspirin, anticoagulation, and ticagrelor coupled with very short medical contact-to-balloon times represent good indicators of optimal treatment of ST-elevation myocardial infarction and an ideal setting to explore which factors may influence coronary reperfusion beyond a well-established pre-hospital system. METHODS: This study sought to evaluate predictors of complete ST-segment resolution after percutaneous coronary intervention in ST-elevation myocardial infarction patients enrolled in the ATLANTIC trial. ST-segment analysis was performed on electrocardiograms recorded at the time of inclusion (pre-hospital electrocardiogram), and one hour after percutaneous coronary intervention (post-percutaneous coronary intervention electrocardiogram) by an independent core laboratory. Complete ST-segment resolution was defined as ≥70% ST-segment resolution. RESULTS: Complete ST-segment resolution occurred post-percutaneous coronary intervention in 54.9% ( n=800/1456) of patients and predicted lower 30-day composite major adverse cardiovascular and cerebrovascular events (odds ratio 0.35, 95% confidence interval 0.19-0.65; p<0.01), definite stent thrombosis (odds ratio 0.18, 95% confidence interval 0.02-0.88; p=0.03), and total mortality (odds ratio 0.43, 95% confidence interval 0.19-0.97; p=0.04). In multivariate analysis, independent negative predictors of complete ST-segment resolution were the time from symptoms to pre-hospital electrocardiogram (odds ratio 0.91, 95% confidence interval 0.85-0.98; p<0.01) and diabetes mellitus (odds ratio 0.6, 95% confidence interval 0.44-0.83; p<0.01); pre-hospital ticagrelor treatment showed a favorable trend for complete ST-segment resolution (odds ratio 1.22, 95% confidence interval 0.99-1.51; p=0.06). CONCLUSIONS: This study confirmed that post-percutaneous coronary intervention complete ST-segment resolution is a valid surrogate marker for cardiovascular clinical outcomes. In the current era of ST-elevation myocardial infarction reperfusion, patients' delay and diabetes mellitus are independent predictors of poor reperfusion and need specific attention in the future.
Entities:
Keywords:
ST segment resolution; ST-elevation myocardial infarction; reperfusion; ticagrelor
Authors: Enrico Fabris; Renicus Hermanides; Vincent Roolvink; Borja Ibanez; Jan Paul Ottervanger; Gonzalo Pizarro; Niels van Royen; Alonso Mateos-Rodriguez; Jan Henk Dambrink; Agustin Albarran; Francisco Fernández-Avilés; Javier Botas; Wouter Remkes; Victoria Hernandez-Jaras; Elvin Kedhi; Jose Zamorano; Fernando Alfonso; Alberto García-Lledó; Maarten van Leeuwen; Robin Nijveldt; Sonja Postma; Evelien Kolkman; Marcel Gosselink; Bart de Smet; Saman Rasoul; Erik Lipsic; Jan J Piek; Valentin Fuster; Arnoud Wj van 't Hof Journal: Open Heart Date: 2020-12
Authors: Wael Sumaya; William A E Parker; Heather M Judge; Ian R Hall; Rachel C Orme; Zulfiquar Adam; James D Richardson; Alexander M K Rothman; Kenneth P Morgan; Julian P Gunn; Robert F Storey Journal: Platelets Date: 2020-06-16 Impact factor: 3.862