A Study of Ticagrelor in the Upstream Setting for Non-ST-Segment Elevation Myocardial Infarction

Overview

About this study

The purpose of this study is to establish a registry that will address the data gap regarding the course of NSTEMI (Non-ST-Elevation Myocardial Infarction) between ED (Emergency Department) arrival and diagnostic angiography in detail, by characterizing and following the ED and peri-ED use of advanced OAP (Oral Anti-Platelet) agents. In addition to exploring ED treatment patterns and success of both ischemic and bleeding risk stratification prior to definition of the coronary anatomy, data generated via the UPSTREAM registry will allow plausible attribution of ischemic and bleeding outcomes to pre-catheterization antiplatelet therapy in the management of NSTEMI. This registry further seeks to demonstrate that contemporary use of upstream ticagrelor is associated with an economically-sound utilization of hospital resources, and smooth transition of care into the outpatient, secondary prevention setting for the first 30 days after hospitalization. Finally, it will allow characterization of patient selection factors and processes for ticagrelor vs alternative OAP agents, carrying out that descriptive comparison through discharge. Patients transferred in to an UPSTREAM hospital are eligible for inclusion, but the timing for OAP agent administration and diagnostic catheterization begin with ED care at the first hospital.

Participation eligibility

Participant eligibility includes age, gender, type and stage of disease, and previous treatments or health concerns. Guidelines differ from study to study, and identify who can or cannot participate. There is no guarantee that every individual who qualifies and wants to participate in a trial will be enrolled. Contact the study team to discuss study eligibility and potential participation.

Inclusion Criteria:

  • Patients ≥ 18 years of age.
  • Have a working diagnosis of NSTEMI and treatment with an OAP agent (ticagrelor, clopidogrel, or prasugrel) either in the ED or within the timeframe that emergency physicians consider to be "upstream"; i.e., within the first 72 hours of care and at least 4 hours before diagnostic angiography.
  • Patients who undergo a diagnostic coronary angiography within 72 hours of ED arrival.

Exclusion Criteria:

  • Patients under 18 years of age.
  • Life expectancy less than 90 days in opinion of treating clinician.
  • Not undergoing diagnostic angiography within 72 hours of ED arrival.
  • Refusal of consent.
  • Unlikely to comply with follow-up by telephone.

Participating Mayo Clinic locations

Study statuses change often. Please contact the study team for the most up-to-date information regarding possible participation.

Mayo Clinic Location Status Contact

Jacksonville, Fla.

Mayo Clinic principal investigator

Johnathan Sheele, M.D., M.P.H.

Contact us for the latest status

Contact information:

Erica Cook

(904)953-3543

Cook.Erica@mayo.edu

More information

Publications

Publications are currently not available