A 30 Day Study to Evaluate Efficacy and Safety of Pre-hospital vs. In-hospital Initiation of Ticagrelor Therapy in STEMI Patients Planned for Percutaneous Coronary Intervention (PCI)

NCT ID: NCT01347580

Last Updated: 2015-07-22

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

1875 participants

Study Classification

INTERVENTIONAL

Study Start Date

2011-09-30

Study Completion Date

2013-11-30

Brief Summary

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The aim of this study is to determine whether initiation of ticagrelor as early as in the ambulance setting leads to a rapid reperfusion of the infarct-related artery therefore facilitating the Percutaneous Coronary Intervention (PCI) and optimizing the outcome for the patient.

The study will assess the efficacy and safety of pre-hospital compared to in-hospital administration of ticagrelor in co-administration with aspirin, on restoring the blood flow in the occluded heart artery and improving the myocardial perfusion in patients suffering from myocardial infarction and planned to have a PCI. Patients can be randomised in either one of the 2 arms:

re-hospital ticagrelor arm: Patients will receive a loading dose of 180 mg ticagrelor for the pre-hospital administration and placebo for in-hospital administration.

or In-hospital ticagrelor arm: Patients will receive a placebo for pre-hospital administration and 180 mg ticagrelor loading dose for in-hospital administration.

Patients are initially managed by ambulance physician/personnel in pre hospital settings. They are then transferred into a Catheterization room to undergo a PCI.

After the administration of the loading dose of ticagrelor (double blind), patients will continue on ticagrelor 90 mg bid and be followed in study for 30 days post randomisation.

Detailed Description

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Conditions

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Myocardial Infarction Segment Elevation Myocardial Infarction (STEMI)

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors

Study Groups

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Ticagrelor

Loading dose of Ticagrelor (180 mg) followed by matching placebo. After the loading dose the patient will receive Ticagrelor (90 mg bid) for 30 days.

Group Type EXPERIMENTAL

Ticagrelor

Intervention Type DRUG

Oral Ticagrelor loading dose (180 mg) followed by matching placebo

Placebo

Placebo followed by a loading dose of Ticagrelor (180 mg). After the loading dose the patient will receive Ticagrelor (90 mg bid) for 30 days.

Group Type EXPERIMENTAL

Placebo

Intervention Type DRUG

Placebo followed by oral Ticagrelor loading dose (180 mg)

Interventions

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Ticagrelor

Oral Ticagrelor loading dose (180 mg) followed by matching placebo

Intervention Type DRUG

Placebo

Placebo followed by oral Ticagrelor loading dose (180 mg)

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Women must not be of child-bearing potential (1 year post-menopausal or surgically sterile).
* Symptoms of acute MI of more than 30 min but less than 6 hours
* New persistent ST-segment elevation ≥ 1 mm in two or more contiguous electrocardiogram (ECG) leads.

Exclusion Criteria

* Expected time to 1st PCI balloon inflation in the hospital, from the qualifying ECG is more than 120 minutes
* Contraindication to ticagrelor (refer to SmPC)
* Concomitant medication that may increase the risk of bleeding \[e.g non steroidal anti-inflammatory drugs (NSAIDs), oral anticoagulant and / or fibrinolytics, planned or administered 24 hours before randomization\]
* Any of the following conditions in the absence of a functioning implanted pacemaker: known SSS, second or third degree AVB, or documented syncope of suspected bradycardic origin.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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AstraZeneca

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Dr Judith Hsia, MD

Role: STUDY_DIRECTOR

AstraZeneca

Pr Gilles Montalescot

Role: PRINCIPAL_INVESTIGATOR

Pitie Salpetriere Hospital

Locations

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Research Site

Algiers, , Algeria

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Blida, , Algeria

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Herston, , Australia

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Southport, , Australia

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Woolloongabba, , Australia

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Graz, , Austria

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Innsbruck, , Austria

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Vienna, , Austria

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Halifax, Nova Scotia, Canada

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Newmarket, Ontario, Canada

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Scarborough Village, Ontario, Canada

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Regina, Saskatchewan, Canada

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Aalborg, , Denmark

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Aarhus, , Denmark

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Odense C, , Denmark

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Aubervilliers, , France

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Besançon, , France

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Boulogne-Billancourt, , France

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Bourges, , France

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Bron, , France

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Châteauroux, , France

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Corbeil-Essonnes, , France

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Créteil, , France

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Dijon, , France

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Lagny-sur-Marne, , France

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Le Chesnay, , France

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Le Coudray, , France

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Lyon, , France

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Marseille, , France

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Massy, , France

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Melun, , France

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Montauban, , France

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Montfermeil, , France

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Montreuil, , France

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Neuilly-sur-Seine, , France

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Nîmes, , France

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Paris, , France

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Pessac, , France

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Quincy-sous-Sénart, , France

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Rouen, , France

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Strasbourg, , France

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Tours, , France

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Vannes, , France

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Bad Friedrichshall, , Germany

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Bad Nauheim, , Germany

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Darmstadt, , Germany

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Esslingen am Neckar, , Germany

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Freiburg im Breisgau, , Germany

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Giessen, , Germany

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Hanover, , Germany

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Ludwigshafen, , Germany

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Lüdenscheid, , Germany

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Mainz, , Germany

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Merseburg, , Germany

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Wuppertal, , Germany

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Budapest, , Hungary

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Debrecen, , Hungary

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Pécs, , Hungary

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Szeged, , Hungary

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Arezzo, , Italy

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Ascoli Piceno, , Italy

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Cona, , Italy

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Forlì, , Italy

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Genova, , Italy

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Grosseto, , Italy

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Massa, , Italy

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Seriate, , Italy

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Siena, , Italy

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's-Hertogenbosch, , Netherlands

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Alkmaar, , Netherlands

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Arnhem, , Netherlands

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Terneuzen, , Netherlands

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A Coruña, , Spain

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Alicante, , Spain

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Badalona, , Spain

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Barcelona, , Spain

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Hospitalet de Llobregat(Barcel, , Spain

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Madrid, , Spain

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Málaga, , Spain

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Santiago(A Coruña), , Spain

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Seville, , Spain

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Vigo(Pontevedra), , Spain

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Gävle, , Sweden

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Linköping, , Sweden

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Örebro, , Sweden

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Uppsala, , Sweden

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Ashford, , United Kingdom

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Belfast, , United Kingdom

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Cambridge, , United Kingdom

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Coventry, , United Kingdom

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Eastbourne, , United Kingdom

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Hastings, , United Kingdom

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Middlesbrough, , United Kingdom

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Newcastle upon Tyne, , United Kingdom

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Norwich, , United Kingdom

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Sheffield, , United Kingdom

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Countries

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Algeria Australia Austria Canada Denmark France Germany Hungary Italy Netherlands Spain Sweden United Kingdom

References

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Montalescot G, van 't Hof AW, Lapostolle F, Silvain J, Lassen JF, Bolognese L, Cantor WJ, Cequier A, Chettibi M, Goodman SG, Hammett CJ, Huber K, Janzon M, Merkely B, Storey RF, Zeymer U, Stibbe O, Ecollan P, Heutz WM, Swahn E, Collet JP, Willems FF, Baradat C, Licour M, Tsatsaris A, Vicaut E, Hamm CW; ATLANTIC Investigators. Prehospital ticagrelor in ST-segment elevation myocardial infarction. N Engl J Med. 2014 Sep 11;371(11):1016-27. doi: 10.1056/NEJMoa1407024. Epub 2014 Sep 1.

Reference Type RESULT
PMID: 25175921 (View on PubMed)

Lapostolle F, Van't Hof AW, Hamm CW, Stibbe O, Ecollan P, Collet JP, Silvain J, Lassen JF, Heutz WMJM, Bolognese L, Cantor WJ, Cequier A, Chettibi M, Goodman SG, Hammett CJ, Huber K, Janzon M, Merkely B, Storey RF, Ten Berg J, Zeymer U, Licour M, Tsatsaris A, Montalescot G; ATLANTIC Investigators. Morphine and Ticagrelor Interaction in Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction: ATLANTIC-Morphine. Am J Cardiovasc Drugs. 2019 Apr;19(2):173-183. doi: 10.1007/s40256-018-0305-0.

Reference Type DERIVED
PMID: 30353444 (View on PubMed)

Fabris E, Van't Hof A, Hamm CW, Lapostolle F, Lassen JF, Goodman SG, Ten Berg JM, Bolognese L, Cequier A, Chettibi M, Hammett CJ, Huber K, Janzon M, Merkely B, Storey RF, Zeymer U, Cantor WJ, Kerneis M, Diallo A, Vicaut E, Montalescot G; ATLANTIC investigators. Pre-hospital administration of ticagrelor in diabetic patients with ST-elevation myocardial infarction undergoing primary angioplasty: A sub-analysis of the ATLANTIC trial. Catheter Cardiovasc Interv. 2019 Jun 1;93(7):E369-E377. doi: 10.1002/ccd.27921. Epub 2018 Oct 9.

Reference Type DERIVED
PMID: 30302940 (View on PubMed)

Bagai A, Goodman SG, Cantor WJ, Vicaut E, Bolognese L, Cequier A, Chettibi M, Hammett CJ, Huber K, Janzon M, Lapostolle F, Lassen JF, Merkely B, Storey RF, Ten Berg JM, Zeymer U, Diallo A, Hamm CW, Tsatsaris A, El Khoury J, Van't Hof AW, Montalescot G. Duration of ischemia and treatment effects of pre- versus in-hospital ticagrelor in patients with ST-segment elevation myocardial infarction: Insights from the ATLANTIC study. Am Heart J. 2018 Feb;196:56-64. doi: 10.1016/j.ahj.2017.10.021. Epub 2017 Nov 4.

Reference Type DERIVED
PMID: 29421015 (View on PubMed)

Kilic S, Fabris E, Van't Hof AWJ, Hamm CW, Lapostolle F, Lassen JF, Tsatsaris A, Diallo A, Vicaut E, Montalescot G; ATLANTIC Investigators. Thrombus aspiration and prehospital ticagrelor administration in ST-elevation myocardial infarction: Findings from the ATLANTIC trial. Am Heart J. 2018 Feb;196:1-8. doi: 10.1016/j.ahj.2017.09.018. Epub 2017 Oct 3.

Reference Type DERIVED
PMID: 29421001 (View on PubMed)

Venetsanos D, Sederholm Lawesson S, Alfredsson J, Janzon M, Cequier A, Chettibi M, Goodman SG, Van't Hof AW, Montalescot G, Swahn E. Association between gender and short-term outcome in patients with ST elevation myocardial infraction participating in the international, prospective, randomised Administration of Ticagrelor in the catheterisation Laboratory or in the Ambulance for New ST elevation myocardial Infarction to open the Coronary artery (ATLANTIC) trial: a prespecified analysis. BMJ Open. 2017 Sep 21;7(9):e015241. doi: 10.1136/bmjopen-2016-015241.

Reference Type DERIVED
PMID: 28939567 (View on PubMed)

Cayla G, Lapostolle F, Ecollan P, Stibbe O, Benezet JF, Henry P, Hammett CJ, Lassen JF, Storey RF, Ten Berg JM, Hamm CW, Van't Hof AW, Montalescot G; ACTION study group. Pre-hospital ticagrelor in ST-segment elevation myocardial infarction in the French ATLANTIC population. Int J Cardiol. 2017 Oct 1;244:49-53. doi: 10.1016/j.ijcard.2017.06.009. Epub 2017 Jun 9.

Reference Type DERIVED
PMID: 28622941 (View on PubMed)

Lupi A, Schaffer A, Lazzero M, Tessitori M, De Martino L, Rognoni A, Bongo AS, Porto I. Pre-hospital ticagrelor in patients with ST-segment elevation myocardial infarction with long transport time to primary PCI facility. Cardiovasc Revasc Med. 2016 Dec;17(8):528-534. doi: 10.1016/j.carrev.2016.08.005. Epub 2016 Aug 20.

Reference Type DERIVED
PMID: 27666002 (View on PubMed)

Silvain J, Storey RF, Cayla G, Esteve JB, Dillinger JG, Rousseau H, Tsatsaris A, Baradat C, Salhi N, Hamm CW, Lapostolle F, Lassen JF, Collet JP, Ten Berg JM, Van't Hof AW, Montalescot G. P2Y12 receptor inhibition and effect of morphine in patients undergoing primary PCI for ST-segment elevation myocardial infarction. The PRIVATE-ATLANTIC study. Thromb Haemost. 2016 Aug 1;116(2):369-78. doi: 10.1160/TH15-12-0944. Epub 2015 May 19.

Reference Type DERIVED
PMID: 27196998 (View on PubMed)

Montalescot G, van 't Hof AW, Bolognese L, Cantor WJ, Cequier A, Chettibi M, Collet JP, Goodman SG, Hammett CJ, Huber K, Janzon M, Lapostolle F, Lassen JF, Licour M, Merkely B, Salhi N, Silvain J, Storey RF, Ten Berg JM, Tsatsaris A, Zeymer U, Vicaut E, Hamm CW; ATLANTIC Investigators. Effect of Pre-Hospital Ticagrelor During the First 24 h After Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction: The ATLANTIC-H(2)(4) Analysis. JACC Cardiovasc Interv. 2016 Apr 11;9(7):646-56. doi: 10.1016/j.jcin.2015.12.024. Epub 2016 Mar 5.

Reference Type DERIVED
PMID: 26952907 (View on PubMed)

Montalescot G, Lassen JF, Hamm CW, Lapostolle F, Silvain J, ten Berg JM, Cantor WJ, Goodman SG, Licour M, Tsatsaris A, van't Hof AW. Ambulance or in-catheterization laboratory administration of ticagrelor for primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: rationale and design of the randomized, double-blind Administration of Ticagrelor in the cath Lab or in the Ambulance for New ST elevation myocardial Infarction to open the Coronary artery (ATLANTIC) study. Am Heart J. 2013 Apr;165(4):515-22. doi: 10.1016/j.ahj.2012.12.015. Epub 2013 Feb 13.

Reference Type DERIVED
PMID: 23537967 (View on PubMed)

Other Identifiers

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D5130L00006

Identifier Type: -

Identifier Source: org_study_id

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