Impact of Prehospital Ticagrelor Loading Dose Combined With Aspirin Dual Antiplatelet Therapy on Post-PCI TIMI Flow Grade in Patients With ST-Elevation Myocardial Infarction.

BACKGROUND: Early dual antiplatelet therapy (DAPT) improves outcomes in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). Although guidelines recommend prompt P2Y12 inhibitor use, the optimal timing of administration, particularly prehospital versus in-hospital delivery, remains uncertain.

OBJECTIVE: This study evaluated whether prehospital ticagrelor loading plus aspirin improves coronary reperfusion and outcomes compared with in-hospital administration in STEMI.

METHODS: We retrospectively analyzed 428 consecutive STEMI patients treated with primary PCI between January 2023 and December 2025. Patients received ticagrelor 180 mg and aspirin 300 mg either prehospital via emergency medical services (n = 186) or after emergency department arrival (n = 242). The primary endpoint was post-PCI Thrombolysis in Myocardial Infarction (TIMI) flow grade 3. Secondary endpoints included myocardial blush grade (MBG), ST-segment resolution, 30-day major adverse cardiovascular events (MACE), and bleeding.

RESULTS: TIMI 3 flow occurred more frequently with prehospital DAPT than with in-hospital administration (91.4% vs. 82.2%, p = 0.007). Complete ST-segment resolution (≥ 70%) was higher in the prehospital group (76.3% vs. 64.5%, p = 0.008), as was MBG 2-3 (84.9% vs. 74.4%, p = 0.009). Time from first medical contact to DAPT was shorter prehospital (8 vs. 42 min, p < 0.001). Prehospital DAPT independently predicted TIMI 3 flow (OR 2.18, 95% CI 1.24-3.84). Thirty-day MACE was reduced (5.4% vs. 11.2%, p = 0.038), without increased major bleeding.

CONCLUSION: Prehospital ticagrelor plus aspirin is associated with superior reperfusion and improved short-term outcomes without excess bleeding, supporting routine implementation within emergency medical services. These findings may inform systems of care and optimize early pharmacologic strategies worldwide in practice.