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No advantage for ticagrelor pretreatment in primary PCI for STEMI
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Pretreatment with ticagrelor compared with ticagrelor given in the cath lab did not improve 30-day outcomes in patients with STEMI undergoing primary PCI, according to new data from the SWEDEHEART register.
The researchers analyzed 7,433 patients who underwent primary PCI for STEMI in Sweden between October 2010 and October 2014. Of those, 5,438 (mean age, 67 years; 70% men) were pretreated with ticagrelor (Brilinta, AstraZeneca) and 1,995 (mean age, 65 years; 73% men) were administered ticagrelor in the cath lab only.
The primary endpoint was all-cause mortality, MI or stent thrombosis at 30 days. Secondary endpoints included the individual components of the primary outcome and in-hospital major bleeding.
Sasha Koul, MD, PhD, from the departments of cardiology and clinical sciences at Skane University Hospital Lund, Lund University, Sweden, and colleagues found the groups did not differ in the primary endpoint (pretreatment group, 6.2%; cath lab group, 6.5%; P = .69), 30-day mortality (pretreatment group, 4.5%; cath lab group, 4.7%; P = .86), 30-day MI (pretreatment group, 1.6%; cath lab group, 1.7%; P = .72) or 30-day stent thrombosis (pretreatment group, 0.5%; cath lab group, 0.4%; P = .8).
There was also no significant difference between the groups in in-hospital bleeding (pretreatment group, 1%; cath lab group, 0.9%).
After adjustments for baseline differences, there remained no significant differences between the groups in any outcomes, Koul and colleagues wrote.
“Our findings suggest no significant difference in a composite endpoint of all-cause mortality/MI/stent thrombosis and mortality, MI or stent thrombosis alone with ticagrelor pretreatment in patients with STEMI undergoing primary PCI,” Koul and colleagues wrote. “These findings, in conjunction with the neutral results of the previously published randomized ATLANTIC trial, suggest that routine administration of ticagrelor pretreatment should be re-evaluated in this patient group.” – by Erik Swain
Disclosures: Koul reports he receives speakers’ honoraria from AstraZeneca. Please see the study for all other authors’ relevant financial disclosures.
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