Pre-hospital ticagrelor in ST-segment elevation myocardial infarction in the French ATLANTIC population

Abstract

Background ATLANTIC was a randomized study comparing pre- and in-hospital treatment with a ticagrelor loading dose (LD) in ongoing ST-segment elevation myocardial infarction (STEMI). We sought to compare patient characteristics and clinical outcomes in France with other countries participating in ATLANTIC. Methods The population comprised 1862 patients, 660 (35.4%) from France and 1202 from 12 other countries. The main endpoints were reperfusion (≥ 70% ST-segment elevation resolution) and TIMI flow grade 3 before (co-primary endpoints) and after percutaneous coronary intervention (PCI). Other endpoints included a composite ischaemic endpoint (death/myocardial infarction/stroke/urgent revascularization/definite stent thrombosis) and bleeding events at 30 days. Results In France, median times from first LD to angiography and between first and second LDs were 49 and 35 min, respectively, and were similar to other countries. French patients were younger (mean 58.7 vs 61.9 years, p < 0.0001) and characterized by a higher rate of radial access (89.9% vs 54.8%, p < 0.0001), more frequent use of pre-hospital glycoprotein (GP) IIb/IIIa inhibitors (14.1% vs 3.1%, p < 0.0001) and intravenous enoxaparin (57.3% vs 10.1%, p < 0.0001). In France, as in other countries, the co-primary endpoints did not differ between the two randomization groups. The composite ischaemic endpoint was numerically lower in France (3.3% vs 5.1%, p = 0.07), with a lower mortality (1.4% vs 3.3%, p = 0.01). PLATO major bleeding was numerically less frequent in France (1.8% vs 3.2%, p = 0.07). Conclusions The French population appears to have better outcomes than the rest of the study population, and seems related to differences in demographics and management characteristics. Trial registry ClinicalTrials.gov (NCT01347580).