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Non-ambulance PowerPoint Presentation

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Slide 1 - Prehospital Fibrinolysis with Double Antiplatelet Therapy in Acute ST-Elevation Myocardial Infarction: The Clarity Ambulance Substudy
Slide 2 - Ambulance Substudy Background Fibrinolysis for ST-elevation acute myocardial infarction (STEMI) is frequently limited by delays of administration as well as incomplete reperfusion or reocclusion of the infarct-related artery1 Intensified prehospital management may shorten time to treatment and improve outcomes2 1. Brouwer MA et al. Circulation 2002; 106: 659–665. 2. Morrison LJ et al. JAMA 2000; 283: 2686–2692.
Slide 3 - Substudy Sites and Patient Numbers France: 172 patients L Soulat: 57 Y Lambert: 48 F Lapostolle: 28 F Thieuleux: 21 C Gully: 10 D Pollet: 5 D Galley: 2 L Olliver: 1 UK: 40 patients J Adgey: 27 J Purvis: 13 Sweden: 5 patients J-E Karlsson: 5 217 patients in total
Slide 4 - Baseline Characteristics: Ambulance vs. Non-Ambulance
Slide 5 - Patient Management: Ambulance vs. Non-Ambulance *p <0.001 versus ambulance patients; values are median unless otherwise specified
Slide 6 - Angiographic & ECG Parameters: Ambulance vs. Non-Ambulance *Complete considered to be >70%; ECG=electrocardiogram p value Event rate (%) Ambulance Non-ambulance Non-ambulance better Ambulance better Odds ratio (95% CI)
Slide 7 - Primary Outcome Parameters: Ambulance vs. Non-Ambulance p value Event rate (%) Ambulance Non-ambulance *Occluded infarct artery (TFG 0/1) + death + re-MI prior to angiography; NS=not significant Ambulance better Non-ambulance better Odds ratio (95% CI)
Slide 8 - Baseline Characteristics: Ambulance Subgroup
Slide 9 - Primary Outcome Parameters: Ambulance Subgroup p value Event rate (%) Clopidogrel Placebo Clopidogrel better Placebo better Odds ratio (95% CI) *Occluded infarct artery (TFG 0/1) + death + re-MI prior to angiography
Slide 10 - 0 0.5 1.0 1.5 2.0 Ambulance Non-ambulance Overall Clopidogrel better Placebo better Odds ratio (95% CI) Primary Endpoint of TIMI Flow Grade 0/1, MI or Death 0.60 (0.301.17) 0.64 (0.530.76) 0.65 (0.540.77)
Slide 11 - Safety: Bleeding Complications TIMI=thrombolysis in myocardial infarction; ICH=intracranial hemorrhage
Slide 12 - Conclusions Medical reperfusion of STEMI patients with fibrinolysis, heparin, ASA and clopidogrel is feasible before reaching the hospital in medically equipped ambulances without an apparent increase in bleeding Early management of patients in the ambulance is associated with shorter ischaemic times and faster reperfusion, with a consistent treatment effect in favour of clopidogrel in comparison with the overall results
 

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