Study Presented at ESC Suggests No Advantage of Ambulance Versus Hospital Antiplatelet Therapy for STEMI Patients
September 5, 2017—The European Society of Cardiology (ESC) announced that a new study presented at the ESC Congress 2017, which was held August 26–30 in Barcelona, Spain, demonstrated that European and American guidelines recommending prehospital antiplatelet therapy for patients with ST-elevation myocardial infarction (STEMI) has no advantage over waiting for in-hospital treatment.
The retrospective study used data from the Swedish Coronary Angiography and Angioplasty Registry to identify 44,804 STEMI patients undergoing percutaneous coronary intervention (PCI) between 2005 and 2016. Most of the patients were pretreated with antiplatelet therapy, but 6,964 were not.
In the ESC press release, study investigator Elmir Omerovic, PhD, with Sahlgrenska University Hospital, Gothenburg, Sweden, commented, “Prehospital administration is common practice—despite the lack of definite evidence for its benefit. But our study, which is the largest cohort study conducted so far, adds to some previous evidence suggesting there is potential for harm. In fact, inadvertent prehospital administration of these drugs to patients with contraindications to antithrombotic therapy is common. Therefore, considering all current evidence, we think prehospital administration should be discouraged.”
As summarized in the ESC announcement, comparing pretreated patients to those not pretreated, the investigators found no significant benefits of pretreatment in terms of 30-day mortality (odds ratio, 0.91; P = .36) or other endpoints including measures of arterial blockage, cardiogenic shock, neurological complications, or bleeding complications.
The ESC noted that it, as well as the American College of Cardiology and American Heart Association, recommends prehospital antiplatelet treatment, but the current study adds to growing evidence that may tip the pendulum.
Dr. Omerovic explained that the ATLANTIC trial, presented at the ESC Congress a few years ago, gave the first hint that pretreatment might offer no advantages, but it was a study with relatively short delays for patients receiving in-hospital treatment. He stated, “Our new data addresses some of the concerns with ATLANTIC and offers stronger evidence that pretreatment is not necessary. We hope the accumulated evidence will be convincing enough to discourage this practice and trigger a change in recommendations.”