Abstract 17491: Impact of Prehospital Administration of Antithrombotic Medications on Infarct-related Artery Patency in ST-elevation Myocardial Infarction: Results from the FAST-MI 2010 Registry

Abstract

Rationale: The role of prehospital (PH) antithrombotic medications in STEMI is debated; real-world data are scarce. We used the FAST-MI 2010 data to assess TIMI flow before PCI, in relation to PH administration of antithrombotic medications and timing of coronary angiography. Methods and Results: FAST-MI is a nationwide French registry including consecutive AMI patients in 213 centers in November 2010. Of 2364 STEMI patients, 2035 had TIMI flow assessed pre-intervention (1458 primary PCI, 289 lysis, 288 no reperfusion therapy); 41% had TIMI flow 2/3. PH use of antithrombotics was: ASA 52%, clopidogrel 37%, prasugrel 7%, GP IIb-IIIa 4%; unfractionated heparin 24%, other anticoagulants 22%. Mean age, risk factors, medical history, GRACE score, location of infarct did not differ between patients with TIMI 2/3 vs 0/1 flow. IRA patency was higher with time from onset to call less than 120min (45% vs 35%, P<0.001), and time from ECG to angio over 120 min (48% vs 33%,P<0.001). In the whole population, % TIMI flow 2/3 was higher with PH lytics (78% vs 42%, P<0.001) and differed according to PH antithrombotic use: no antiplatelet 42%, ASA alone 39%, clopidogrel 53.5%, prasugrel 58%, GPIIb-IIIa 40%; no anticoagulant 43%, UFH 46%, other anticoagulants 55%. Lysis (OR 5.67, 3.67-8.77), and combination of dual antiplatelets and anticoagulants (OR 1.59, 1.20-2.12) were independent correlates of higher patency. In patients with primary PCI, individual medications were not significantly correlated with IRA patency. Combined dual antiplatelet and anticoagulants, however, was a significant correlate of higher TIMI2/3 flow (adjusted OR 1.43, 1.05-1.96), as were shorter duration from onset to call (OR 1.53, 1.13-2.08) and longer time from ECG to angio (OR upper tertile vs lower tertile 1.65, 1.14-2.37). ST-segment resolution, reinfarction, stent thrombosis and TIMI major bleeding did not differ according to PH antithrombotics. Conclusion: In the whole population of STEMI patients (including lytic-treated patients), as in patients with primary PCI, PH administration of combined antiplatelet and anticoagulants is associated with increased IRA patency. In contrast, none of the individual antithrombotic medications significantly improved IRA patency.