Prasugrel reduced ischemic outcomes more than did clopidogrel in patients receiving stents for ACS

Randomized controlled trial (Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel-Thrombolysis in Myocardial Infarction [TRITON-TIMI] 38 study).

{Concealed}†.*

Blinded ({patients, clinicians, data collectors,}† and outcome assessors).*

A median 14.5 months.

{707 clinical sites in 30 countries}.‡

12 844 patients (median age 60 y, 74% men; based on 12 204 patients) with ACS who received bare-metal (n = 6461) or drug-eluting (n = 5743) stents. Key exclusion criteria included history of bleeding diathesis or use of thienopyridine within the past 5 days.

Prasugrel, 60-mg loading dose, followed by maintenance dose of 10 mg/d (n = 6422), or clopidogrel, 300-mg loading dose, followed by maintenance dose of 75 mg/d (n = 6422).

Primary composite endpoint of cardiovascular (CV) death, nonfatal myocardial infarction (MI), or nonfatal stroke. Secondary outcomes included the composite of all-cause death, nonfatal MI, nonfatal stroke, or nonfatal major bleeding unrelated to coronary bypass grafting; urgent target vessel revascularization (UTVR); and ST.

{99.9%}‡ (intention-to-treat analysis).

Both composite endpoints, MI, UTVR, and ST were lower in the prasugrel group (Table). Groups did not differ for CV death or major bleeding (Table).

Prasugrel reduced ischemic events and stent thrombosis more than did clopidogrel in patients with the acute coronary syndrome who received ≥ 1 stent.