William B. Hillegass, MD, MPH; Brigitta C. Brott, MD
In patients having percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI), how does prasugrel (PSG) compare with clopidogrel (CPDG) for ischemic events?
Randomized controlled trial (TRial to assess Improvement in Therapeutic Outcomes by optimizing platelet inhibitioN with prasugrel–Thrombolysis In Myocardial Infarction [TRITON-TIMI] 38). ClinicalTrials.gov NCT00097591.
Blinded (patients and clinicians).*
707 sites in 30 countries.
3534 patients 51 to 69 years of age (77% men) having PCI for STEMI. Exclusion criteria included need for long-term oral anticoagulants, receipt of thienopyridine within 5 days of randomization, cardiogenic shock, receipt of fibrinolytic agents in the past 24 to 48 hours, and high bleeding risk or anemia.
PSG (loading dose, 60 mg; maintenance dose, 10 mg/d for 15 mo) (n = 1769) or CPDG (loading dose, 300 mg; maintenance dose, 75 mg/d for 15 mo) (n = 1765).
Composite of CV death, nonfatal MI, or nonfatal stroke. Secondary outcomes included the composite of CV death, MI, or urgent target vessel revascularization (UTVR); stent thrombosis; and thrombolysis in MI (TIMI) major bleeding unrelated to coronary artery bypass grafting (CABG).
99.9% (intention-to-treat analysis).
PSG reduced both composite endpoints and stent thrombosis compared with CPDG (Table). Groups did not differ for TIMI major bleeding unrelated to CABG.
Prasugrel prevented ischemic events compared with clopidogrel in patients having percutaneous coronary intervention for ST-elevation myocardial infarction.
Prasugrel vs clopidogrel in patients having percutaneous coronary intervention for ST-elevation myocardial infarction (MI)†
†Abbreviations defined in Glossary. RRR and CI calculated from control event rates and hazard ratios in article.
‡Cardiovascular death (2.4% vs 3.4%), MI (6.8% vs 9%), and stroke (1.6% vs 1.5%).
§Cardiovascular death, MI, and urgent target vessel revascularization (2.2% vs 3.2%).
Hillegass WB, Brott BC. Prasugrel prevented ischemic events compared with clopidogrel in patients having PCI for STEMI. Ann Intern Med. ;150:JC6–10. doi: 10.7326/0003-4819-150-12-200906160-02010
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Published: Ann Intern Med. 2009;150(12):JC6-10.
Acute Coronary Syndromes, Cardiology, Coronary Heart Disease, Emergency Medicine.
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