Double-Blind, Randomized, Prospective Comparison of Loading Doses of 600 mg Clopidogrel Versus 60 mg Prasugrel in Patients With Acute ST-Segment Elevation Myocardial Infarction Scheduled for Primary Percutaneous Intervention: The ETAMI Trial (Early Thienopyridine treatment to improve primary PCI in Patients with Acute Myocardial Infarction)

Uwe Zeymer; Hans-Christian Mochmann; Bernd Mark; Hans-Richard Arntz; Holger Thiele; Frank Diller; Gilles Montalescot; Ralf Zahn

doi:10.1016/j.jcin.2014.09.007

JACC: Cardiovascular Interventions

Volume 8, Issue 1 Part B, January 2015 DOI: 10.1016/j.jcin.2014.09.007

Double-Blind, Randomized, Prospective Comparison of Loading Doses of 600 mg Clopidogrel Versus 60 mg Prasugrel in Patients With Acute ST-Segment Elevation Myocardial Infarction Scheduled for Primary Percutaneous Intervention
The ETAMI Trial (Early Thienopyridine treatment to improve primary PCI in Patients with Acute Myocardial Infarction)

Uwe Zeymer, Hans-Christian Mochmann, Bernd Mark, Hans-Richard Arntz, Holger Thiele, Frank Diller, Gilles Montalescot and Ralf Zahn

Author + information

vol. 8 no. 1 Part B 147-154

DOI:

https://doi.org/10.1016/j.jcin.2014.09.007

Published By:

JACC: Cardiovascular Interventions

Print ISSN:

1936-8798

Online ISSN:

1876-7605

History:

Received June 20, 2014
Revision received August 15, 2014
Accepted September 10, 2014
Published online January 1, 2015.

2015 American College of Cardiology Foundation

Author Information

Uwe Zeymer, MD^∗^∗ (zeymeru{at}klilu.de),
Hans-Christian Mochmann, MD^†,
Bernd Mark, MD^‡,
Hans-Richard Arntz, MD^†,
Holger Thiele, MD^§,
Frank Diller^‖,
Gilles Montalescot, MD^¶ and
Ralf Zahn, MD^‡

^∗Klinikum Ludwigshafen and Institut für Herzinfarkt für Herzinfarktforschung, Ludwigshafen, Germany
^†Charite Campus Benjamin Franklin, Berlin, Germany
^‡Klinikum Ludwigshafen, Ludwigshafen, Germany
^§Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
^‖Institut für Herzinfartktforschung, Ludwigshafen, Germany
^¶Centre Hospitalier Universitaire Pitié-Salpêtriėre, INSERM UMRS 1166, Paris, France

↵∗Reprint requests and correspondence:
Prof. Dr. Uwe Zeymer, Klinikum Ludwigshafen and Institut für Herzinfarktforschung Ludwighafen, Bremserstrasse 79, 67063 Ludwigshafen, Germany.

Abstract

Objectives This study compared the timing of onset of antiplatelet action after treatment with clopidogrel and prasugrel at first medical contact in patients with ST-segment elevation myocardial infarction (STEMI) scheduled for primary percutaneous coronary intervention (PPCI).

Background Little is known about the timing of onset of antiplatelet action after a pre-percutaneous coronary intervention (PCI) loading dose of clopidogrel or prasugrel in patients with STEMI.

Methods This double-blind, prospective study randomized 62 patients with STEMI scheduled for PPCI in the ambulance or the emergency department to 60 mg prasugrel (n = 31) or 600 mg clopidogrel (n = 31). The primary endpoint was the platelet reactivity index (PRI) measured with the vasodilator-stimulated phosphoprotein assay 2 h after intake of the study medication. Secondary endpoints were PRI after 4 h, TIMI (Thrombolysis In Myocardial Infarction) patency of the infarct-related artery before and after PCI, and clinical events until day 30.

Results The PRI after 2 h (50.4 ± 32.7% vs. 66.3 ± 22.2%; p = 0.035) and after 4 h (39.1 ± 27.5% vs. 54.5 ± 49.3%; p = 0.038) were significantly lower with prasugrel compared with clopidogrel. In addition, the rate of patients with a PRI <50% tended to be higher with prasugrel compared with clopidogrel after 2 h (46.7% vs. 28.6%; p = 0.15) and after 4 h (63.0% vs. 38.9%; p = 0.06). There were no significant differences in TIMI 2/3 patency before PCI (39.2% vs. 31.0%; p = 0.43) and TIMI 3 patency after PCI (88.5% vs. 89.3%; p = 0.92).

Conclusions The pre-PCI administration of prasugrel in patients with STEMI undergoing PPCI was associated with a significant faster platelet inhibition compared with clopidogrel. Therefore, prasugrel should be preferred to clopidogrel in this setting. (ETAMI-Study: Early Thienopyridine Treatment to Improve Primary PCI in Patients With Acute Myocardial Infarction; NCT01327534)

Key Words

Footnotes

This study was funded by Daiichi Sankyo and the Stiftung Institut für Herzinfarktforschung Ludwigshafen. Dr. Zeymer has received research funding from Eli Lilly, Daiichi Sankyo, and Sanofi; has received speakers honoraria from AstraZeneca, Daiichi Sankyo, Eli Lilly, and Sanofi; and has served on the advisory board of AstraZeneca, Daiichi Sankyo, Lilly, and The Medicines Company. Dr. Arntz has received speakers honoraria from Daiichi Sankyo and Eli Lilly. Dr. Thiele has received research funding from Eli Lilly; and has received speakers honoraria from Eli Lilly, Daiichi Sankyo, AstraZeneca, and Boehringer Ingelheim. Dr. Montalescot has received consulting fees from Bayer, Boehringer Ingelheim, Europa, GlaxoSmithKline, Iroko Cardio International, Lead-Up, Novartis, Springer, TIMI Group, WebMD, and Wolters; and has received consulting fees and grant support from Bristol-Myers Squibb, AstraZeneca, Biotronik, Eli Lilly, the Medicines Company, Medtronic, Menarini, Roche, and Sanofi-Aventis. Dr. Zahn has received speakers honoraria from Daiichi Sankyo and Eli Lilly. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.