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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
- Source :
- Circulation. 119:2758-2764
- Publication Year :
- 2009
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2009.
-
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 P =0.0002) and nonprocedural (type 1, 2, or 3) MIs (2.8% versus 3.7%; HR, 0.72; 95% CI, 0.59 to 0.88; P =0.0013) and consistently across MI size, including MIs with a biomarker peak ≥5 times the reference limit (HR. 0.74; 95% CI, 0.64 to 0.86; P =0.0001). In landmark analyses starting at 30 days, patients treated with prasugrel had a lower risk of any MI (2.9% versus 3.7%; HR, 0.77; P =0.014), including nonprocedural MI (2.3% versus 3.1%; HR, 0.74; 95% CI, 0.60 to 0.92; P =0.0069). Conclusion— Treatment with prasugrel compared with clopidogrel for up to 15 months in patients with acute coronary syndrome undergoing percutaneous coronary intervention significantly reduces the risk of MIs that are procedure related and spontaneous and those that are small and large, including new MIs occurring during maintenance therapy.
- Subjects :
- medicine.medical_specialty
Acute coronary syndrome
Ticlopidine
Time Factors
Prasugrel
Thienopyridine
medicine.medical_treatment
Myocardial Infarction
Kaplan-Meier Estimate
Thiophenes
Piperazines
Double-Blind Method
Troponin T
Recurrence
Physiology (medical)
Internal medicine
medicine
Creatine Kinase, MB Form
Humans
Angina, Unstable
Myocardial infarction
Acute Coronary Syndrome
Angioplasty, Balloon, Coronary
Prasugrel Hydrochloride
Unstable angina
business.industry
Incidence
Percutaneous coronary intervention
medicine.disease
Clopidogrel
Combined Modality Therapy
Death, Sudden, Cardiac
Cardiology
Cardiology and Cardiovascular Medicine
business
Biomarkers
Platelet Aggregation Inhibitors
medicine.drug
Subjects
Details
- ISSN :
- 15244539 and 00097322
- Volume :
- 119
- Database :
- OpenAIRE
- Journal :
- Circulation
- Accession number :
- edsair.doi.dedup.....2af365d4c26db82506663b3bed188f3b