Prasugrel versus clopidogrel in acute coronary syndromes treated with PCI

Effects on clinical outcome according to culprit artery location

Stefano De Servi, Jochen Goedicke, Marco Ferlini, Tullio Palmerini, Mikko Syvänne, Gilles Montalescot

Research output: Contribution to journalArticle

Abstract

Background Acute coronary syndrome (ACS) mortality increases when the culprit lesion is in the left anterior descending (LAD) artery. We investigated the effects of prasugrel versus clopidogrel according to site of culprit lesion causing ACS treated with percutaneous coronary intervention (PCI) in the TRITON–TIMI 38 study. Methods Patients were divided into three groups based on the native coronary artery culprit lesion location. The LAD artery group included also patients with the culprit lesion in the left main (LM) artery. Results In the whole ACS population, prasugrel recipients had lower rates of the primary endpoint that included cardiovascular (CV) death, non-fatal myocardial infarction (MI) or non-fatal stroke without significant differences across vessel groups. CV death was significantly decreased with prasugrel in the whole ACS population (p = 0.03) and in ST-elevation MI (STEMI) patients undergoing primary PCI (p = 0.04), with pronounced differences in favour of prasugrel versus clopidogrel when the LAD-LM was the culprit vessel (relative risk reduction 50% in the whole ACS population, 57% in STEMI treated with primary PCI, p for interaction 0.07 and 0.08 respectively). Conclusions Prasugrel effects were particularly favourable when LAD-LM was the culprit vessel, resulting in CV mortality reduction in the whole ACS population and in STEMI patients when treated with primary PCI.

Original languageEnglish
Pages (from-to)632-638
Number of pages7
JournalInternational Journal of Cardiology
Volume223
DOIs
Publication statusPublished - Nov 15 2016

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clopidogrel
Percutaneous Coronary Intervention
Acute Coronary Syndrome
Arteries
Population
Mortality
Risk Reduction Behavior
Prasugrel Hydrochloride
Coronary Vessels
Stroke
Myocardial Infarction

Keywords

  • Acute coronary syndromes
  • P2Y12 inhibitors
  • Prasugrel

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine

Cite this

Prasugrel versus clopidogrel in acute coronary syndromes treated with PCI : Effects on clinical outcome according to culprit artery location. / De Servi, Stefano; Goedicke, Jochen; Ferlini, Marco; Palmerini, Tullio; Syvänne, Mikko; Montalescot, Gilles.

In: International Journal of Cardiology, Vol. 223, 15.11.2016, p. 632-638.

Research output: Contribution to journalArticle

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