Summary
The recently published Administration of Ticagrelor in the Cath Lab or in the Ambulance
for New ST Elevation Myocardial Infarction to Open the Coronary Artery (ATLANTIC)
trial concluded that prehospital administration of ticagrelor in patients with acute
STEMI appeared to be safe but did not improve pre-PCI coronary reperfusion. The ATLANTIC
data fully support the PLATO Angiographic Substudy denying early benefit of ticagrelor,
and correspond well with lack of immediate clinical benefit including the early PCI
“death paradox„ in PLATO-USA patients. Finally, there were significantly (p=0.043)
more deaths in early ticagrelor ATLANTIC arm (odds ratio 3.18 (1.02–9.90) challenging
stent thrombosis reduction. Indeed, ATLANTIC represents an important step for our
better understanding of ticagrelor, although the confirmation of the PLATO mortality
wonder in an adequately powered PEGASUS (TIMI-54) to be reported in 2015 will be vital
for ticagrelor future.
