• Alessandro Lupi, Alon Schaffer, Maurizio Lazzero, Massimo Tessitori, Leonardo De Martino, Andrea Rognoni, Angelo S Bongo, and Italo Porto.
• 2nd Cardiology Division, AOU Maggiore della Carità, Novara, Italy; Cardiology Clinic, Eastern Piedmont University, AOU Maggiore della Carità, Novara, Italy. Electronic address: lupialessandro1@gmail.com.
• Cardiovasc Revasc Med. 2016 Dec 1; 17 (8): 528-534.

BackgroundPre-hospital ticagrelor, given less than 1h before coronary intervention (PCI), failed to improve coronary reperfusion in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary PCI. It is unknown whether a longer interval from ticagrelor administration to primary PCI might reveal any improvement of coronary reperfusion.MethodsWe retrospectively compared 143 patients, pre-treated in spoke centers or ambulance with ticagrelor at least 1.5h before PCI (Pre-treatment Group), with 143 propensity score-matched controls treated with ticagrelor in the hub before primary PCI (Control Group) extracted from RENOVAMI, a large observational Italian registry of more than 1400 STEMI patients enrolled from Jan. 2012 to Oct. 2015 (ClinicalTrials.gov id: NCT01347580). The median time from ticagrelor administration and PCI was 2.08h (95% CI 1.66-2.84) in the Pre-treatment Group and 0.56h (95% CI 0.33-0.76) in the Control Group. TIMI flow grade before primary PCI in the infarct related artery was the primary endpoint.ResultsThe primary endpoint, baseline TIMI flow grade, was significantly higher in Pre-treatment Group (0.88±1.14 vs 0.53±0.86, P=0.02). However in-hospital mortality, in-hospital stent thrombosis, bleeding rates and other clinical and angiographic outcomes were similar in the two groups.ConclusionsIn a real world STEMI network, pre-treatment with ticagrelor in spoke hospitals or in ambulance loading at least 1.5h before primary PCI is safe and might improve pre-PCI coronary reperfusion, in comparison with ticagrelor administration immediately before PCI.Copyright © 2016 Elsevier Inc. All rights reserved.

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