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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...

Authors :
Zeymer, Uwe
Mochmann, Hans-Christian
Mark, Bernd
Arntz, Hans-Richard
Thiele, Holger
Diller, Frank
Montalescot, Gilles
Zahn, Ralf
Source :
JACC: Cardiovascular Interventions; Jan2015 Part B, Vol. 8 Issue 1, p147-154, 8p
Publication Year :
2015

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 ) [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
19368798
Volume :
8
Issue :
1
Database :
Supplemental Index
Journal :
JACC: Cardiovascular Interventions
Publication Type :
Academic Journal
Accession number :
100363743
Full Text :
https://doi.org/10.1016/j.jcin.2014.09.007