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New oral antiplatelet drugs (prasugrel, ticagrelor) are recommended in the current European Society of Cardiology guidelines for the management of patients presenting with ST-segment elevation myocardial infarction (STEMI) [1]. However, in many STEMI hospital networks administration of a 600-mg clopidogrel loading dose before or during transfer to cathlab (including in ambulance administration) is a standard of care, since this strategy has been implemented for many years. Early administration of the drug may enhance antiplatelet effects of clopidogrel at the time of primary percutaneous coronary intervention (PCI), in comparison to the administration in the cathlab. On the other hand, the response to clopidogrel in patients with STEMI, especially in patients with hemodynamic compromise is impaired. Prasugrel and ticagrelor are more potent antiplatelet drugs, with faster and more profound antiplatelet effect. These agents are preferred over clopidogrel, if not contraindicated, in patients with STEMI since both are superior in comparison to clopidogrel in terms of the reduction of ischemic events [2, 3]. However, introduction of prasugrel and ticagrelor may need to change STEMI network logistics since those new drugs are predominantly administered in the cathlab, but not in ambulances or in non-PCI centers before transportation [4]. In our high-volume primary PCI center, early (before transfer to cathlab) administration of acetylsalicylic acid, unfractionated heparin and a 600-mg clopidogrel loading dose has been a well-established standard of treatment from many years. In-cathlab administration of antiplatelet drugs was a rare strategy so it was necessary to reorganize STEMI network for new antiplatelet drugs introduction in daily practice. An observational, prospective registry was designed to describe the implementation of new oral antiplatelet drugs in our network. First 100 consecutive STEMI patients (no exclusion criteria) admitted to our center after introduction of prasugrel and ticagrelor were enrolled. Registry was focused on antiplatelet therapy including type of drug, moment of administration, time from administration to PCI. Data on reason for the administration of clopidogrel instead of new drugs was also collected. Additionally, platelet aggregation inhibition was assessed at the time of PCI (guide wire introduction) with Plateletworks Aggregation Kits (Helena Laboratories, Beaumont, TX, USA) [5]. The registry analyzed the current clinical practice and did not modify patients diagnostics and treatment. A total of 100 consecutive STEMI patients entered the registry. Clinical characteristics of patient population are presented in Table 1. Registry represents real life STEMI population including elderly patients and patients in cardiogenic shock. Acetylsalicylic acid was administered before transfer to cathlab in all patients. New oral antiplatelet drugs were given after cathlab admission before or during coronary angiography only in 15 out of 100 patients (13 patients treated with a 60-mg prasugrel loading dose; 2 patients treated with a 180-mg ticagrelor loading dose). In the remaining 85 patients a 600-mg clopidogrel loading T. Rakowski (&) A. Dziewierz Z. Siudak P. Kleczynski J. S. Dubiel Second Department of Cardiology, Jagiellonian University Medical College, Kopernika 17 Street, 31-501 Krakow, Poland e-mail: mcrakows@cyfronet.pl

Introduction of new oral antiplatelet drugs in myocardial infarction hospital network: initial experience