Author + information
- Ajay Ramanakumar1,
- Rishi Bajaj1,
- Aniruddha Singh1,
- Sourbha Dani1,
- Zainab Basheer2 and
- Joseph Hannan1
The aim of this study is to compare the efficacy and safety of prasugrel 60 mg vs. clopidogrel 600 mg loading doses in patients undergoing primary PCI for acute STEMI.
There is ever increasing evidence to suggest that potent antiplatelet therapy plays a crucial role in the management of patients with Acute Coronary syndromes (ACS). Recent randomized trial demonstrated greater reduction in infarct size with clopidogrel 600 mg vs. 300 mg loading doses in patients undergoing primary PCI for STEMI. While the Triton TIMI 38 trial demonstrated superiority of prasugrel 60 mg to clopidogrel 300 mg load in patients with ACS, to our knowledge there has never been a head to head comparison between prasugrel 60 mg vs. clopidogrel 600 mg loading doses.
This was a retrospective observational study comparing patients presenting with acute STEMI, who were treated with prasugrel 60 mg vs. clopidogrel 600 mg loading doses. These were sequential patients based on a protocol driven change from clopidogrel to prasugrel. The primary end point was the evaluation of infarct size, based on peak CK and CK-MB elevation. Secondary end points include global discharge LVEF and TIMI flow grade before and after PCI. Safety endpoint was in-hospital bleeding complications.
Mean age of the study subjects was 56 years, with 82% being males. There was no statistically significant difference between the two groups in terms of infarct size. The peak CK was 1442 ± 1128 U/L in the prasugrel group (n=38) vs. 1522 ± 1467 U/L in the clopidogrel group (n=34) (p=0.79). The peak CK-MB was 132 ± 100 ng/ml in the prasugrel group vs. 123 ±117 ng/ml in the clopidogrel group (p=0.73). Similarly, there were no significant differences in the prespecified secondary end points and safety end point.
In patients undergoing primary PCI for acute STEMI, pretreatment with prasugrel 60 mg vs. clopidogrel 600 mg was not associated with significant difference in infarct size. These findings support the need for additional randomized trials to determine the relative efficacy of these two different strategies in the acute STEMI population.
- 2013 American College of Cardiology Foundation