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Prehospital ticagrelor in ST-segment elevation myocardial infarction

Methodology Score: 4/5

Usefulness Score: 3/5


Montalescot G, van 't Hof AW, Lapostolle F, et al. for the ATLANTIC Investigators.
N Engl J Med. 2014 Sep 11;371(11):1016-27.


This corporate-sponsored international, multicenter, RCT randomized 1,862 STEMI patients to receive ticagrelor prehospital vs in-hospital and found no difference in outcomes (70% or greater reduction of ST-segment elevation prior to PCI and/or a relatively good flow in the culprit artery (TIMI grade 3)); there was also no difference in morbidity and mortality at 30 days. These results should discourage EMS services from administering prehospital ticagrelor. 
By: Dr. Jaroslav Fabian
(Presented March 2015)


Epi lesson: Concealment versus Blinding   
These clinical trial terms have different meanings but are often confused. Concealment refers to the process whereby the treatment allocation is made unknown or concealed prior to patient randomization. This helps prevent selection bias by ensuring that health providers and research staff are not tempted to include or exclude cases according to their views on the allocated treatment. Blinding refers to the methods employed after randomization to ensure that patients, health care providers, and research staff cannot determine whether the patient is receiving the study or the control treatment. This reduces ascertainment bias (the likelihood of differential assessment of outcome).

By: Dr. Ian Stiell 

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