Effect of the novel thienopyridine prasugrel compared with clopidogrel on spontaneous and procedural myocardial infarction in the trial to assess improvement in therapeutic outcomes by optimizing platelet inhibition with prasugrel-thrombolysis in myocardial infarction 38: An application of the classification system from the universal definition of myocardial infarction

David A. Morrow, Stephen D. Wiviott, Harvey D. White, Jose C. Nicolau, Ezio Bramucci, Sabina A. Murphy, Marc P. Bonaca, Christian T. Ruff, Benjamin M. Scirica, Carolyn H. McCabe, Elliott M. Antman, Eugene Braunwald

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND-Prasugrel is a novel thienopyridine that reduces new or recurrent myocardial infarctions (MIs) compared with clopidogrel in patients with acute coronary syndrome undergoing percutaneous coronary intervention. This effect must be balanced against an increased bleeding risk. We aimed to characterize the effect of prasugrel with respect to the type, size, and timing of MI using the universal classification of MI. METHODS AND RESULTS-We studied 13 608 patients with acute coronary syndrome undergoing percutaneous coronary intervention randomized to prasugrel or clopidogrel and treated for 6 to 15 months in the Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition With Prasugrel-Thrombolysis in Myocardial Infarction (TRITON-TIMI 38). Each MI underwent supplemental classification as spontaneous, secondary, or sudden cardiac death (types 1, 2, and 3) or procedure related (Types 4 and 5) and examined events occurring early and after 30 days. Prasugrel significantly reduced the overall risk of MI (7.4% versus 9.7%; hazard ratio [HR], 0.76; 95% confidence interval [CI], 0.67 to 0.85; P

Original languageEnglish
Pages (from-to)2758-2764
Number of pages7
JournalCirculation
Volume119
Issue number21
DOIs
Publication statusPublished - Jun 2 2009

Keywords

  • Angioplasty
  • Myocardial infarction
  • Platelets
  • Prasugrel
  • Unstable angina

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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